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General NPI Number Information
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NPI Number | 1376793414
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Entity Type | Organization
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Legal Business Name | KINGS 26 DENTISTRY
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 10504 CROSSBAY BLVD 2ND FLOOR
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City | OZONE PARK
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State | NY
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Zip | 11417-1515
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Country | US
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Telephone | 718-843-4444
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Fax | 718-843-5097
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Provider Business Mailing Address
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Address Line | 10504 CROSSBAY BLVD 2ND FLOOR
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City | OZONE PARK
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State | NY
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Zip | 11417-1515
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Country | US
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Telephone | 718-843-4444
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Fax | 718-843-5097
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Authorized Official
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Title or Position | PRIMARY PROVIDER
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Name | MR. FARAMARZ KHALILI
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Credential | DDS
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Telephone | 718-843-4444
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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 | 047305
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License Number State | NY
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