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General NPI Number Information
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NPI Number | 1467959577
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Entity Type | Organization
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Legal Business Name | TSOMO DENTAL PC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 4030 75TH ST STE 1A
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City | ELMHURST
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State | NY
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Zip | 11373-1054
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Country | US
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Telephone | 718-779-2985
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Fax | 718-424-8659
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Provider Business Mailing Address
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Address Line | 4030 75TH ST STE 1A
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City | ELMHURST
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State | NY
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Zip | 11373-1054
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Country | US
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Telephone | 718-779-2985
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Fax | 718-424-8659
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LOBSANG TSOMO
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Credential | DMD
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Telephone | 718-779-2985
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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 | 055162
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License Number State | NY
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