Roosevelt 26 Dental Group Pllc | |
10308 Roosevelt Ave Corona NY 11368-2330 | |
(917) 391-8000 | |
Not Available |
Full Name | Roosevelt 26 Dental Group Pllc |
---|---|
Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 10308 Roosevelt Ave, Corona, New York |
Authorized Official Name and Position | Faramarz Khalili (OWNER) |
Authorized Official Contact | 5163828000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Roosevelt 26 Dental Group Pllc 10308 Roosevelt Ave Corona NY 11368-2330 Ph: (917) 391-8000 | Roosevelt 26 Dental Group Pllc 10308 Roosevelt Ave Corona NY 11368-2330 Ph: (917) 391-8000 |
NPI Number | 1407319239 |
---|---|
Provider Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407319239 | NPI | - | NPPES |
03060184 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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