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General NPI Number Information
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NPI Number | 1598418832
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Entity Type | Organization
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Legal Business Name | METROPOLITAN DENTAL & ANESTHESIOLOGY P.C.
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 3540 82ND ST STE 1G
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5159
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Country | US
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Telephone | 718-446-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 82ND ST STE 1G
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5159
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Country | US
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Telephone | 718-446-7100
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES JACKSON
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Credential | DMD
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Telephone | 718-446-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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