Corona Pediatric Dental Plaza | |
10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 | |
(718) 397-7000 | |
Not Available |
Full Name | Corona Pediatric Dental Plaza |
---|---|
Speciality | Dentist |
Location | 10308 Roosevelt Ave, Corona, New York |
Authorized Official Name and Position | Alicia A Pitkouvich (MANAGER) |
Authorized Official Contact | 9173918000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Corona Pediatric Dental Plaza 10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 Ph: (718) 397-7000 | Corona Pediatric Dental Plaza 10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 Ph: (718) 397-7000 |
NPI Number | 1245632207 |
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Provider Enumeration Date | 09/22/2014 |
Last Update Date | 09/22/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245632207 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 055939 (New York) | Primary |
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