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General NPI Number Information
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NPI Number | 1831402536
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Entity Type | Organization
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Legal Business Name | AUSTIN DENTAL CARE, P.C.
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 10210 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3100
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Provider Business Mailing Address
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Address Line | 10210 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3100
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Country | US
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Telephone | 718-544-4440
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Fax | 718-233-2723
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. DAVID TABAROKI
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Credential | DDS
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Telephone | 718-544-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 052330
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 047690
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License Number State | NY
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