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Organization
QUEENS DENTAL GROUP
Active
Organization
QUEENS DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DE LORENZO DMD (DENTIST)
(703) 870-1415
Entity
Organization
Contact information
Practice address
11148 157TH ST, JAMAICA, NY 11433-3726
(703) 870-1415
Mailing address
11148 157TH ST, JAMAICA, NY 11433-3726
(703) 870-1415
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
040975
NY
Other
Enumeration date
10/14/2014
Last updated
10/14/2014
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