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General NPI Number Information
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NPI Number | 1730337577
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Entity Type | Organization
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Legal Business Name | QUEENS VILLAGE DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 10/07/2017
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Provider Practice Location Address
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Address Line | 221-10 JAMAICA A. SUITE 103
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428
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Country | US
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Telephone | 718-464-9216
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Fax | 718-464-3953
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Provider Business Mailing Address
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Address Line | 221-10 JAMAICA A. SUITE 103
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428
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Country | US
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Telephone | 718-464-9216
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Fax | 718-464-3953
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. JONATHAN ADAM FLAX
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Credential | D.M.D.
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Telephone | 718-464-9216
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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 | 043437
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 043393
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License Number State | NY
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