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General NPI Number Information
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NPI Number | 1346581410
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Entity Type | Organization
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Legal Business Name | ALAVI-LIN DENTAL PC
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 5123 QUEENS BLVD OFFICE 1, DENTIST
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City | WOODSIDE
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State | NY
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Zip | 11377-4587
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Country | US
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Telephone | 718-440-9272
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Fax | 718-440-9797
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Provider Business Mailing Address
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Address Line | 5123 QUEENS BLVD OFFICE 1, DENTIST
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City | WOODSIDE
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State | NY
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Zip | 11377-4587
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Country | US
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Telephone | 718-440-9272
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Fax | 718-440-9797
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Authorized Official
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Title or Position | PROSTHODONTIST
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Name | DR. MOHAMMAD ALAVI
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Credential | DDS
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Telephone | 310-713-9588
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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 | 055123
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License Number State | NY
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