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Organization
ROOSEVELT 26 DENTISTRY P.C.
Active
Organization
ROOSEVELT 26 DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARAMARZ KHALILI (OWNER)
(718) 779-2626
Entity
Organization
Contact information
Practice address
103-10 ROOSEVELT AVENUE, 2ND FLR, CORONA, NY 11368
(718) 779-2626
Mailing address
10310 ROOSEVELT AVE FL 2, CORONA, NY 11368-2330
(718) 779-2626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01804719
—
NY
Enumeration date
10/19/2010
Last updated
10/19/2010
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