| Aestheticaredental | |
|
21816 Hillside Ave Queens Village NY 11427-1951 | |
| (917) 579-2194 | |
| Not Available |
| Full Name | Aestheticaredental |
|---|---|
| Speciality | Dentist |
| Location | 21816 Hillside Ave, Queens Village, New York |
| Authorized Official Name and Position | Mohammad Reazul Haque (VICE PRESIDENT) |
| Authorized Official Contact | 9175792194 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aestheticaredental 21816 Hillside Ave Queens Village NY 11427-1951 Ph: (917) 579-2194 | Aestheticaredental 21816 Hillside Ave Queens Village NY 11427-1951 Ph: (917) 579-2194 |
| NPI Number | 1972872430 |
|---|---|
| Provider Enumeration Date | 12/29/2011 |
| Last Update Date | 12/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972872430 | NPI | - | NPPES |
| 03283552 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 055217 (New York) | Primary |
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