MEDICARE: ALLIANCE DENTAL P.C.

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	:	1750475935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE DENTAL P.C.

Provider Business Mailing Address
First Line	:	8411 NORTHERN BLVD
Second Line	:	FIRST FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1531
Country	:	US
Telephone Number	:	718-424-7100
Fax Number	:	718-424-7898

Provider Business Practice Location Address
First Line	:	8411 NORTHERN BLVD
Second Line	:	FIRST FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1531
Country	:	US
Telephone Number	:	718-424-7100
Fax Number	:	718-424-7898

Authorized Official
Title or Position	:	CEO
Name	:	VENIAMIN LEVANT
Credential	:	DDS
Telephone Number	:	718-424-7100

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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Directions to “ALLIANCE DENTAL P.C. ” Practice Location

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