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General NPI Number Information
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NPI Number | 1336498070
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Entity Type | Organization
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Legal Business Name | BELLEROSE DENTAL P.C.
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 102-32 JAMAICA AVENUE
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City | QUEENS
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State | NY
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Zip | 11418
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Country | US
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Telephone | 718-575-1889
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Fax |
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Provider Business Mailing Address
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Address Line | 72-36 112TH STREET APT.612
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City | FOREST HILLS
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State | NY
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Zip | 11375
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Country | US
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Telephone | 718-575-1889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IOSIF UVAYDOV
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Credential | DDS
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Telephone | 718-575-1889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 044283
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License Number State | NY
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