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General NPI Number Information
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NPI Number | 1639384530
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Entity Type | Organization
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Legal Business Name | FOREST HILLS DENTAL CARE
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11301 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-5555
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Country | US
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Telephone | 718-575-5090
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Fax | 718-575-3874
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Provider Business Mailing Address
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Address Line | 11301 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-5555
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Country | US
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Telephone | 718-575-5090
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Fax | 718-575-3874
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUSAN M. LEVINE
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Credential | D.M.D.
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Telephone | 718-575-5090
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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 | 041882
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License Number State | NY
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