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General NPI Number Information
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NPI Number | 1992978126
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Entity Type | Organization
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Legal Business Name | QUEENSBORO DENTAL PC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 15034 UNION TPKE
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City | FLUSHING
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State | NY
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Zip | 11367-3928
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Country | US
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Telephone | 718-380-0011
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Fax | 718-820-0841
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Provider Business Mailing Address
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Address Line | 15034 UNION TPKE
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City | FLUSHING
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State | NY
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Zip | 11367-3928
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Country | US
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Telephone | 718-380-0011
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Fax | 718-820-0841
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROXANA M
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Credential |
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Telephone | 718-380-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 045477
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License Number State | NY
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