Roosevelt 26 Dentistry P.c. | |
103-10 Roosevelt Avenue, 2nd Flr Corona NY 11368 | |
(718) 779-2626 | |
Not Available |
Full Name | Roosevelt 26 Dentistry P.c. |
---|---|
Speciality | Dentist - General Practice |
Location | 103-10 Roosevelt Avenue, 2nd Flr, Corona, New York |
Authorized Official Name and Position | Faramarz Khalili (OWNER) |
Authorized Official Contact | 7187792626 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Roosevelt 26 Dentistry P.c. 10310 Roosevelt Ave Fl 2 Corona NY 11368-2330 Ph: (718) 779-2626 | Roosevelt 26 Dentistry P.c. 103-10 Roosevelt Avenue, 2nd Flr Corona NY 11368 Ph: (718) 779-2626 |
NPI Number | 1114237518 |
---|---|
Provider Enumeration Date | 10/19/2010 |
Last Update Date | 10/19/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114237518 | NPI | - | NPPES |
01804719 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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