| Roosevelt 26 Dental Group Pllc | |
|
10308 Roosevelt Ave Corona NY 11368-2330 | |
| (917) 391-8000 | |
| Not Available |
| Full Name | Roosevelt 26 Dental Group Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 10308 Roosevelt Ave, Corona, New York |
| Authorized Official Name and Position | Faramarz Khalili (OWNER) |
| Authorized Official Contact | 5163828000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roosevelt 26 Dental Group Pllc 10308 Roosevelt Ave Corona NY 11368-2330 Ph: (917) 391-8000 | Roosevelt 26 Dental Group Pllc 10308 Roosevelt Ave Corona NY 11368-2330 Ph: (917) 391-8000 |
| NPI Number | 1407319239 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 04/09/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407319239 | NPI | - | NPPES |
| 03060184 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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