| Hollis Advanced Dental Care P.c. | |
|
19002 Jamaica Ave 2 Floor Hollis NY 11423-2516 | |
| (718) 454-7418 | |
| (718) 217-2657 |
| Full Name | Hollis Advanced Dental Care P.c. |
|---|---|
| Speciality | Dentist |
| Location | 19002 Jamaica Ave, Hollis, New York |
| Authorized Official Name and Position | Benjamin V Katayev (PRESIDENT) |
| Authorized Official Contact | 7184547418 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hollis Advanced Dental Care P.c. 19002 Jamaica Ave 2 Floor Hollis NY 11423-2516 Ph: (718) 454-7418 | Hollis Advanced Dental Care P.c. 19002 Jamaica Ave 2 Floor Hollis NY 11423-2516 Ph: (718) 454-7418 |
| NPI Number | 1699922088 |
|---|---|
| Provider Enumeration Date | 08/27/2008 |
| Last Update Date | 08/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699922088 | NPI | - | NPPES |
| 011896900 | Medicaid | NY | |
| 02587795 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (New York) | Primary |
| 1223P0300X | Dentist - Periodontics | (New York) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (New York) | Secondary |
Hollis Multi-specialty Dental Group P.c Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 19002 Jamaica Ave., Hollis, NY 11423 Phone: 718-454-7418 Fax: 718-217-2657 | |
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