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General NPI Number Information
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NPI Number | 1245525351
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Entity Type | Organization
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Legal Business Name | PESANTES DENTAL PC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 11109 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2323
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Country | US
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Telephone | 718-850-1011
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Fax | 718-850-6086
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Provider Business Mailing Address
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Address Line | 11109 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2323
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Country | US
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Telephone | 718-850-1011
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Fax | 718-850-6086
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN J PESANTES
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Credential | D.D.S.
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Telephone | 718-850-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046461
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License Number State | NY
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