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General NPI Number Information
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NPI Number | 1881991214
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Entity Type | Organization
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Legal Business Name | DEBORAHNINADENTALOFFICEPC
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 9203 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7941
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Country | US
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Telephone | 718-429-6622
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Fax | 718-429-6669
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Provider Business Mailing Address
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Address Line | 9203 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7941
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Country | US
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Telephone | 718-429-6622
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Fax | 718-429-6669
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH NINA
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Credential | DDS
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Telephone | 718-429-6622
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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 | 055474-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 048101-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 048800-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052578-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 055242-1
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 050127-1
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License Number State | NY
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