| 104 Dental, Pllc | |
|
10423 Roosevelt Avenue Corona NY 11368-2327 | |
| (718) 426-3000 | |
| (718) 426-3002 |
| Full Name | 104 Dental, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10423 Roosevelt Avenue, Corona, New York |
| Authorized Official Name and Position | Artin Sakhaee (OWNER) |
| Authorized Official Contact | 7184767801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 104 Dental, Pllc 10423 Roosevelt Avenue Corona NY 11368-2327 Ph: (718) 426-3000 | 104 Dental, Pllc 10423 Roosevelt Avenue Corona NY 11368-2327 Ph: (718) 426-3000 |
| NPI Number | 1104356476 |
|---|---|
| Provider Enumeration Date | 06/19/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104356476 | NPI | - | NPPES |
| 052701 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 052701 (New York) | Primary |
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