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Organization
ROOSEVELT DENTAL CARE III P.C.
Active
Organization
ROOSEVELT DENTAL CARE III P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN OSTIAGO D.D.S. (OWNER)
(718) 205-7709
Entity
Organization
Contact information
Practice address
10324 ROOSEVELT AVE, SUITE 200, CORONA, NY 11368-2330
(718) 205-7709
(718) 205-7718
Mailing address
10324 ROOSEVELT AVE, SUITE 200, CORONA, NY 11368-2330
(718) 205-7709
(718) 205-7718
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
051025
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02907959
—
NY
Enumeration date
02/11/2008
Last updated
02/11/2008
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