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General NPI Number Information
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NPI Number | 1407685043
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Entity Type | Organization
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Legal Business Name | VILLAGE DENTISTRY PLLC
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 11055 72ND RD STE L1
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City | FOREST HILLS
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State | NY
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Zip | 11375-5420
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Country | US
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Telephone | 718-618-6294
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Fax | 718-263-0701
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Provider Business Mailing Address
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Address Line | 11055 72ND RD STE L1
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City | FOREST HILLS
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State | NY
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Zip | 11375-5420
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Country | US
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Telephone | 718-618-6294
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Fax | 718-263-0701
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOEL PREMINGER
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Credential | DMD
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Telephone | 516-481-1446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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