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Organization
QUEENS SMILE DENTAL P.C.
Active
Organization
QUEENS SMILE DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLGA ZAVULUNOVA D.D.S. (OWNER)
(718) 459-0591
Entity
Organization
Contact information
Practice address
98-76 QUEENS BLVD, # 1 E, REGO PARK, NY 11374-4300
(718) 459-0591
(718) 275-1355
Mailing address
98-76 QUEENS BLVD, # 1 E, REGO PARK, NY 11374-4300
(718) 459-0591
(718) 275-1355
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
047357
NY
1223G0001X
General Practice Dentistry
047357
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01778936
—
NY
Enumeration date
02/04/2008
Last updated
02/04/2008
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