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General NPI Number Information
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NPI Number | 1497087019
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Entity Type | Organization
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Legal Business Name | SUZANNE DENTAL P.C.
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 02/06/2010
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Provider Practice Location Address
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Address Line | 10525 63RD DR
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City | FOREST HILLS
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State | NY
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Zip | 11375-1601
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Country | US
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Telephone | 347-885-4796
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Fax |
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Provider Business Mailing Address
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Address Line | 10525 63RD DR
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City | FOREST HILLS
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State | NY
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Zip | 11375-1601
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Country | US
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Telephone | 347-885-4796
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYUZANNA ISMAILOVA-ARONOV
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Credential | DDS
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Telephone | 347-885-4796
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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 | 054068-1
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License Number State | NY
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