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General NPI Number Information
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NPI Number | 1932565850
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Entity Type | Organization
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Legal Business Name | PRECISION PERIODONTICS NYC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 20124 43RD AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-2545
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Country | US
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Telephone | 718-224-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 20124 43RD AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-2545
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Country | US
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Telephone | 718-224-8280
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRENE BOKSER
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Credential | DDS
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Telephone | 718-224-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 048861-1
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License Number State | NY
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