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General NPI Number Information
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NPI Number | 1821225822
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Entity Type | Organization
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Legal Business Name | LUCKY DENTAL PC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 6555 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-5048
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Country | US
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Telephone | 917-834-2219
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Fax | 914-428-6537
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Provider Business Mailing Address
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Address Line | 6555 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-5048
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Country | US
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Telephone | 917-834-2219
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Fax | 914-428-6537
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEKSANDR AZBEL
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Credential | D.D.S
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Telephone | 917-834-2219
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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 | 046043-1
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License Number State | NY
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