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General NPI Number Information
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NPI Number | 1952960742
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Entity Type | Organization
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Legal Business Name | RADIANT STAR DENTAL PLLC
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 8820 169TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-4431
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Country | US
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Telephone | 718-739-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 16 HORSESHOE LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-1112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUMIT SEHGAL
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Credential | DDS
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Telephone | 516-236-4415
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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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