| Glendale Boutique Dental | |
|
6835 Myrtle Ave Glendale NY 11385-7234 | |
| (718) 821-0170 | |
| Not Available |
| Full Name | Glendale Boutique Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 6835 Myrtle Ave, Glendale, New York |
| Authorized Official Name and Position | Yelena M Mullakandova (OWNER/DENTIST) |
| Authorized Official Contact | 9176401100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glendale Boutique Dental 6835 Myrtle Ave Glendale NY 11385-7234 Ph: (718) 821-0170 | Glendale Boutique Dental 6835 Myrtle Ave Glendale NY 11385-7234 Ph: (718) 821-0170 |
| NPI Number | 1285079962 |
|---|---|
| Provider Enumeration Date | 05/07/2013 |
| Last Update Date | 07/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285079962 | NPI | - | NPPES |
| 03263605 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 055256 (New York) | Primary |
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