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General NPI Number Information
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NPI Number | 1922316652
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Entity Type | Organization
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Legal Business Name | LI DENTAL GROUP, LLP.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 601 FRANKLIN AVE SUITE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-5795
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Country | US
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Telephone | 516-579-0330
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Fax | 516-977-9679
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Provider Business Mailing Address
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Address Line | 601 FRANKLIN AVE SUITE #100
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City | GARDEN CITY
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State | NY
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Zip | 11530-5795
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Country | US
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Telephone | 516-579-0330
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Fax | 516-977-9679
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ARMAN ROKSAR
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Credential | D.D.S.
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Telephone | 516-579-0330
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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 | 054549
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046933
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 046545
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License Number State | NY
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