MEDICARE: GLENDALE DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1588703847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE DENTAL PC

Provider Business Mailing Address
First Line	:	7407 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-386-2655
Fax Number	:	718-497-1243

Provider Business Practice Location Address
First Line	:	7407 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-386-2655
Fax Number	:	718-497-1243

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARTHUR E ASADORIAN
Credential	:
Telephone Number	:	718-386-2655

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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