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General NPI Number Information
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NPI Number | 1841289436
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Entity Type | Organization
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Legal Business Name | LEWIS R BRESTIN DDSPC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17331 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-5523
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Country | US
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Telephone | 718-526-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 17331 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-5523
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Country | US
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Telephone | 718-526-7000
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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. LEWIS R BRESTIN
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Credential |
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Telephone | 718-526-7000
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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 | 22246
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License Number State | NY
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