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General NPI Number Information
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NPI Number | 1609278233
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Entity Type | Organization
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Legal Business Name | WOODHAVEN DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 8708 WOODHAVEN BLVD 2ND FLOOR
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City | WOODHAVEN
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State | NY
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Zip | 11421-2284
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Country | US
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Telephone | 718-850-5555
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Fax | 718-805-9000
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Provider Business Mailing Address
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Address Line | 8708 WOODHAVEN BLVD 2ND FLOOR
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City | WOODHAVEN
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State | NY
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Zip | 11421-2284
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Country | US
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Telephone | 718-850-5555
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Fax | 718-805-9000
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DANIEL KUNCIO
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Credential | DDS
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Telephone | 718-850-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 051019
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 051019
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 051019
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License Number State | NY
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