MEDICARE: PEDIATRIC DENTAL WORLD, 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	1223P0221X	Pediatric Dentistry	053544	NY

General Provider Information

NPI Number	:	1629366703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL WORLD, PC

Provider Business Mailing Address
First Line	:	3209 82ND ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	718-478-2825
Fax Number	:	718-478-2831

Provider Business Practice Location Address
First Line	:	3209 82ND ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	718-478-2825
Fax Number	:	718-478-2831

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DESIREE LARACUENTE
Credential	:	DMD
Telephone Number	:	718-478-2825

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	03/06/2026

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