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General NPI Number Information
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NPI Number | 1518614916
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Entity Type | Organization
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Legal Business Name | THRIVE DENTAL PLLC
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 03/05/2022
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Provider Practice Location Address
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Address Line | 4102 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-2792
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Country | US
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Telephone | 917-825-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 21 WENWOOD DR
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City | GLEN HEAD
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State | NY
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Zip | 11545-3127
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Country | US
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Telephone | 917-825-6622
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DR. YELENA MIKHAYLOVA
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Credential |
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Telephone | 917-825-6622
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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 |
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License Number State |
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