| Eten Dental | |
|
21814 Northern Blvd Ste 104 Bayside NY 11361-3580 | |
| (184) 231-0107 | |
| (718) 423-1011 |
| Full Name | Eten Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 21814 Northern Blvd Ste 104, Bayside, New York |
| Authorized Official Name and Position | Eju Hwang (OWNER) |
| Authorized Official Contact | 7184231010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eten Dental 46 Winthrop Dr Woodbury NY 11797-1315 Ph: (516) 584-6528 | Eten Dental 21814 Northern Blvd Ste 104 Bayside NY 11361-3580 Ph: (184) 231-0107 |
| NPI Number | 1457923872 |
|---|---|
| Provider Enumeration Date | 07/14/2021 |
| Last Update Date | 08/13/2021 |
| Medicare PECOS PAC ID | 5496150930 |
|---|---|
| Medicare Enrollment ID | O20210823001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457923872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Eju Hwang |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1558574855 PECOS PAC ID: 2264731561 Enrollment ID: I20210823001509 |
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