| Richard P. Medina, Dds, Llc | |
|
3719 88th St 1st Fl Jackson Heights NY 11372-7630 | |
| (718) 685-0031 | |
| (718) 685-0033 |
| Full Name | Richard P. Medina, Dds, Llc |
|---|---|
| Speciality | Dentist |
| Location | 3719 88th St, Jackson Heights, New York |
| Authorized Official Name and Position | Richard P Medina (OWNER) |
| Authorized Official Contact | 7186850031 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard P. Medina, Dds, Llc 3719 88th St 1st Fl Jackson Heights NY 11372-7630 Ph: (718) 685-0031 | Richard P. Medina, Dds, Llc 3719 88th St 1st Fl Jackson Heights NY 11372-7630 Ph: (718) 685-0031 |
| NPI Number | 1053586164 |
|---|---|
| Provider Enumeration Date | 04/29/2008 |
| Last Update Date | 12/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053586164 | NPI | - | NPPES |
| 02146005 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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