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General NPI Number Information
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NPI Number | 1306148127
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Entity Type | Organization
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Legal Business Name | DYNAMIC DENTISTRY LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 17515 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-5525
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Country | US
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Telephone | 718-297-4100
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Fax | 718-297-4104
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Provider Business Mailing Address
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Address Line | 17515 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-5525
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Country | US
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Telephone | 718-297-4100
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Fax | 718-297-4104
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Authorized Official
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Title or Position | CO-OWNER
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Name | ADAM LUBLIN
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Credential |
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Telephone | 718-297-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 022580
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 051908
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 031327
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 032158
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 044929
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License Number State | NY
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