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General NPI Number Information
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NPI Number | 1295253607
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Entity Type | Organization
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Legal Business Name | NORTH ISLAND DENTAL ARTS CORP.
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 1613 HILLSIDE AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2603
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Country | US
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Telephone | 516-616-4800
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Fax | 315-825-4788
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Provider Business Mailing Address
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Address Line | 129 MOORE ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1344
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Country | US
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Telephone | 718-916-3900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAILASH KAUR
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Credential |
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Telephone | 718-916-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 58414-1
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License Number State | NY
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