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General NPI Number Information
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NPI Number | 1558497529
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Entity Type | Organization
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Legal Business Name | EVAN P. MONDSHINE, D.D.S., P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 6836 108TH ST STE B10
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City | FOREST HILLS
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State | NY
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Zip | 11375-3366
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Country | US
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Telephone | 718-268-1561
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Fax | 718-268-1577
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Provider Business Mailing Address
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Address Line | 6836 108TH ST STE B10
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City | FOREST HILLS
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State | NY
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Zip | 11375-3366
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Country | US
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Telephone | 718-268-1561
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Fax | 718-268-1577
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Authorized Official
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Title or Position | OWNER
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Name | EVAN P MONDSHINE
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Credential | D.D.S.
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Telephone | 718-268-1561
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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 | 031513
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License Number State | NY
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