| Roosevelt 26 Dentistry P.c. | |
|
103-10 Roosevelt Avenue, 2nd Flr Corona NY 11368 | |
| (718) 779-2626 | |
| Not Available |
| Full Name | Roosevelt 26 Dentistry P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 103-10 Roosevelt Avenue, 2nd Flr, Corona, New York |
| Authorized Official Name and Position | Faramarz Khalili (OWNER) |
| Authorized Official Contact | 7187792626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roosevelt 26 Dentistry P.c. 10310 Roosevelt Ave Fl 2 Corona NY 11368-2330 Ph: (718) 779-2626 | Roosevelt 26 Dentistry P.c. 103-10 Roosevelt Avenue, 2nd Flr Corona NY 11368 Ph: (718) 779-2626 |
| NPI Number | 1114237518 |
|---|---|
| Provider Enumeration Date | 10/19/2010 |
| Last Update Date | 10/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114237518 | NPI | - | NPPES |
| 01804719 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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