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General NPI Number Information
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NPI Number | 1912172339
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Entity Type | Organization
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Legal Business Name | QUALITY DENTAL CARE OF NY
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Dates
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Enumeration Date | 04/26/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 161 MADISON AVE RM 8NE
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City | NEW YORK
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State | NY
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Zip | 10016-5467
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Country | US
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Telephone | 212-532-3893
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Fax |
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Provider Business Mailing Address
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Address Line | 9945 65TH AVE
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City | REGO PARK
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State | NY
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Zip | 11374-3652
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Country | US
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Telephone | 212-532-3893
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OKSANA YAKUBOVA
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Credential | DDS
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Telephone | 212-532-3893
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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 |
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License Number State |
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