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General NPI Number Information
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NPI Number | 1245635937
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Entity Type | Organization
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Legal Business Name | RICHMOND HILL FAMILY DENTAL PC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 114-7 101ST AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-805-1358
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Fax |
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Provider Business Mailing Address
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Address Line | 114-7 101ST AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA JOLLY
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Credential | DMD
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Telephone | 504-669-1304
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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 | 056262
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License Number State | NY
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