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General NPI Number Information
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NPI Number | 1992285357
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Entity Type | Organization
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Legal Business Name | JERICHO ORTHODONTICS AND PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 325 N BROADWAY
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City | JERICHO
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State | NY
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Zip | 11753-2015
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Country | US
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Telephone | 917-657-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SHERWOOD LN
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2511
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Country | US
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Telephone | 917-657-3934
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID CHOI
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Credential | DDS
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Telephone | 917-657-3934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9574651
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 054937
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License Number State | NY
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