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Organization
QUEENSVILLAGEDENTALCARE,P.C.
Active
Organization
QUEENSVILLAGEDENTALCARE,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERENCE TEEKAH MAHASE D.D.S (PRESIDENT)
(718) 465-3265
Entity
Organization
Contact information
Practice address
22005 94TH DR, QUEENS VILLAGE, NY 11428-2105
(718) 465-3265
(718) 776-4260
Mailing address
22005 94TH DR, QUEENS VILLAGE, NY 11428-2105
(718) 465-3265
(718) 776-4260
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
042201
NY
Other
Enumeration date
07/27/2015
Last updated
07/27/2015
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