# ORAL AND MAXILLOFACIAL SURGERY OF QUEENS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487935391
- **Authorized official:** DR. ARIAN SADEGHI (MANAGER)
- **Authorized official phone:** (718) 565-5005

## Contact information

- **Practice address:** 3775 103RD ST, CORONA, NY 11368-1979
- **Practice address phone:** (718) 565-5005
- **Mailing address:** 3775 103RD ST, CORONA, NY 11368-1979

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 051861 | NY | Yes |

## Other

- **Enumeration date:** 09/06/2011
- **Last updated:** 09/06/2011