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General NPI Number Information
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NPI Number | 1861815730
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Entity Type | Organization
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Legal Business Name | WHITESTONE PERIODONTICS AND DENTAL IMPLANTS PLLC
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 16032 20TH AVE
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City | WHITESTONE
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State | NY
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Zip | 11357-3905
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Country | US
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Telephone | 718-423-4500
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Fax | 718-423-4268
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Provider Business Mailing Address
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Address Line | 16032 20TH AVE
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City | WHITESTONE
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State | NY
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Zip | 11357-3905
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Country | US
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Telephone | 718-423-4500
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Fax | 718-423-5268
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Authorized Official
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Title or Position | MANAGER
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Name | ANNA DALESSANDRO
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Credential |
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Telephone | 718-423-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 043648
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License Number State | NY
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