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General NPI Number Information
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NPI Number | 1639381916
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Entity Type | Individual
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Provider Name | EDNA IBAY NAVALTA MAGSOMBOL D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 37-11 QUEENS BLVD
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101
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Country | US
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Telephone | 718-361-5155
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Fax | 718-361-5156
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Provider Business Mailing Address
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Address Line | 90-05 187TH PLACE
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City | HOLLIS
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State | NY
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Zip | 11423
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Country | US
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Telephone | 718-217-7155
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Fax | 718-361-5156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 044382
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License Number State | NY
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