| Wyckoff Dental Pc | |
|
321 Wyckoff Avenue Ridgewood NY 11385 | |
| (718) 386-3288 | |
| (718) 386-3540 |
| Full Name | Wyckoff Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 321 Wyckoff Avenue, Ridgewood, New York |
| Authorized Official Name and Position | Rufina Louis (PRESIDENT) |
| Authorized Official Contact | 7183863288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyckoff Dental Pc 321 Wyckoff Avenue Ridgewood NY 11385 Ph: (718) 386-3288 | Wyckoff Dental Pc 321 Wyckoff Avenue Ridgewood NY 11385 Ph: (718) 386-3288 |
| NPI Number | 1861463366 |
|---|---|
| Provider Enumeration Date | 02/01/2006 |
| Last Update Date | 12/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861463366 | NPI | - | NPPES |
| 01812615 | Medicaid | NY | |
| 02310121 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 043062 (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | 02310121 (* (Not Available)) | Secondary |
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