| Liberty 786 Dentistry | |
|
11302 Liberty Ave South Richmond Hill NY 11419-1808 | |
| (718) 322-4200 | |
| (718) 322-1144 |
| Full Name | Liberty 786 Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 11302 Liberty Ave, South Richmond Hill, New York |
| Authorized Official Name and Position | Rbeea M Khan (D.D.S) |
| Authorized Official Contact | 7183224200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty 786 Dentistry 11302 Liberty Ave South Richmond Hill NY 11419-1808 Ph: (718) 322-4200 | Liberty 786 Dentistry 11302 Liberty Ave South Richmond Hill NY 11419-1808 Ph: (718) 322-4200 |
| NPI Number | 1700161338 |
|---|---|
| Provider Enumeration Date | 10/14/2011 |
| Last Update Date | 10/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700161338 | NPI | - | NPPES |
| 03060184 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 054968-1 (New York) | Primary |
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