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General NPI Number Information
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NPI Number | 1770974164
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Entity Type | Organization
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Legal Business Name | DAVID'S DENTAL, P.C.
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 21404 18TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360-1636
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Country | US
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Telephone | 718-423-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 21404 18TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360-1636
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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 | PRESIDENT
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Name | DR. KINSUN DAVID FUNG
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Credential | D.M.D., M.S.
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Telephone | 718-423-1999
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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 | 057332
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License Number State | NY
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