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General NPI Number Information
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NPI Number | 1699056978
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Entity Type | Organization
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Legal Business Name | JAMAICA 18 DENTISTRY P.C.
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 8701 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2037
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Country | US
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Telephone | 718-850-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER/DENTIST
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Name | DR. ASHKAN NASIM
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Credential | D.M.D.
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Telephone | 718-850-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 054971
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License Number State | NY
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