| Queens Family Dental Office Pc | |
|
9506 Roosevelt Ave Jackson Heights NY 11372-8029 | |
| (718) 507-9100 | |
| (718) 507-7377 |
| Full Name | Queens Family Dental Office Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9506 Roosevelt Ave, Jackson Heights, New York |
| Authorized Official Name and Position | Patria Reynoso (PRESIDENT) |
| Authorized Official Contact | 7185079100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Queens Family Dental Office Pc 9506 Roosevelt Ave Jackson Heights NY 11372-8029 Ph: (718) 507-9100 | Queens Family Dental Office Pc 9506 Roosevelt Ave Jackson Heights NY 11372-8029 Ph: (718) 507-9100 |
| NPI Number | 1902077670 |
|---|---|
| Provider Enumeration Date | 03/20/2008 |
| Last Update Date | 03/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902077670 | NPI | - | NPPES |
| 01676782 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0465601 (New York) | Primary |
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