| Roosevelt Dental Care Iii P.c. | |
|
10324 Roosevelt Ave Suite 200 Corona NY 11368-2330 | |
| (718) 205-7709 | |
| (718) 205-7718 |
| Full Name | Roosevelt Dental Care Iii P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10324 Roosevelt Ave, Corona, New York |
| Authorized Official Name and Position | Edwin Ostiago (OWNER) |
| Authorized Official Contact | 7182057709 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roosevelt Dental Care Iii P.c. 10324 Roosevelt Ave Suite 200 Corona NY 11368-2330 Ph: (718) 205-7709 | Roosevelt Dental Care Iii P.c. 10324 Roosevelt Ave Suite 200 Corona NY 11368-2330 Ph: (718) 205-7709 |
| NPI Number | 1437327616 |
|---|---|
| Provider Enumeration Date | 02/11/2008 |
| Last Update Date | 02/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437327616 | NPI | - | NPPES |
| 02907959 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 051025 (New York) | Primary |
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