| Ideal Smile Dental, P.c. | |
|
9123 Queens Blvd # B Elmhurst NY 11373-5531 | |
| (718) 205-2055 | |
| (718) 205-2355 |
| Full Name | Ideal Smile Dental, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9123 Queens Blvd # B, Elmhurst, New York |
| Authorized Official Name and Position | Yuri Reshetnikov (OWNER) |
| Authorized Official Contact | 7182052055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Smile Dental, P.c. Po Box 740059 Rego Park NY 11374-0059 Ph: (718) 205-2055 | Ideal Smile Dental, P.c. 9123 Queens Blvd # B Elmhurst NY 11373-5531 Ph: (718) 205-2055 |
| NPI Number | 1548685357 |
|---|---|
| Provider Enumeration Date | 03/03/2014 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548685357 | NPI | - | NPPES |
| 02457909 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 050616 (New York) | Primary |
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