| 82nd Dental Pllc | |
|
8201 Roosevelt Ave 2nd Floor Jackson Heights NY 11372-7034 | |
| (718) 476-5555 | |
| (718) 476-6666 |
| Full Name | 82nd Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8201 Roosevelt Ave, Jackson Heights, New York |
| Authorized Official Name and Position | Faramarz Khalili (PRIMARY PROVIDER) |
| Authorized Official Contact | 7184765555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 82nd Dental Pllc 8201 Roosevelt Ave 2nd Floor Jackson Heights NY 11372-7034 Ph: (718) 476-5555 | 82nd Dental Pllc 8201 Roosevelt Ave 2nd Floor Jackson Heights NY 11372-7034 Ph: (718) 476-5555 |
| NPI Number | 1205086147 |
|---|---|
| Provider Enumeration Date | 09/29/2008 |
| Last Update Date | 09/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205086147 | NPI | - | NPPES |
| 01804719 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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