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General NPI Number Information
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NPI Number | 1659354975
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Entity Type | Organization
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Legal Business Name | ADVANCED QUALITY DENTAL HEALTH PC
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 4016 83RD ST ADVANCED QUALITY DENTAL HEALTH PC
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City | ELMHURST
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State | NY
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Zip | 11373-1307
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Country | US
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Telephone | 718-899-5309
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Fax | 718-899-5309
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Provider Business Mailing Address
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Address Line | 4016 83RD ST ADVANCED QUALITY DENTAL HEALTH PC
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City | ELMHURST
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State | NY
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Zip | 11373-1307
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Country | US
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Telephone | 718-899-5309
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Fax | 718-899-5309
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Authorized Official
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Title or Position | OWNER PRESIDENT DENTIST
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Name | DR. CARLINA DAMIANOU
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Credential | DMD
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Telephone | 718-899-5309
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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 | 0406371
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License Number State | NY
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