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Organization
X COLLADO DENTAL CENTER
Active
Organization
X COLLADO DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA X COLLADO-MEDINA D.D.S (X COLLADO DENTAL CENTER)
(718) 323-1288
Entity
Organization
Contact information
Practice address
10105 77TH ST, OZONE PARK, NY 11416-1904
(718) 323-1288
(718) 323-0291
Mailing address
10105 77TH ST, OZONE PARK, NY 11416-1904
(718) 323-1288
(718) 323-0291
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
045798-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01558754
—
NY
Enumeration date
10/30/2009
Last updated
10/30/2009
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