# MEDIDENTAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MediDental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518439967
- **Authorized official:** MR. EMANUEL INOYATOV (CEO)
- **Authorized official phone:** (347) 283-2396

## Contact information

- **Practice address:** 2246 31ST ST, ASTORIA, NY 11105-2786
- **Practice address phone:** (347) 283-2396
- **Mailing address:** 2246 31ST ST, ASTORIA, NY 11105-2786
- **Mailing address phone:** (347) 283-2396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2018
- **Last updated:** 04/15/2025