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Organization
BOUTIQUE DENTAL
Active
Organization
BOUTIQUE DENTAL
Active
Other names
Glendale Boutique DentAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YELENA M MULLAKANDOVA DDS (OWNER/DENTIST)
(917) 640-1100
Entity
Organization
Contact information
Practice address
6835 MYRTLE AVE, GLENDALE, NY 11385-7234
(718) 821-0170
Mailing address
6835 MYRTLE AVE, GLENDALE, NY 11385-7234
(718) 821-0170
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
055256
NY
Other
Enumeration date
05/07/2013
Last updated
07/19/2014
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