# STATEN ISLAND DENTAL BOUTIQUE

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

## Provider details

- **NPI number:** 1770295255
- **Authorized official:** DR. OLENA RONAN DDS (OWNER)
- **Authorized official phone:** (347) 596-7719

## Contact information

- **Practice address:** 1735 RICHMOND AVE FL 2, STATEN ISLAND, NY 10314-3907
- **Practice address phone:** (347) 596-7719
- **Mailing address:** 81 NARROWS RD N APT D, STATEN ISLAND, NY 10305-2818
- **Mailing address phone:** (347) 596-7719

## Taxonomy

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

## Other

- **Enumeration date:** 12/16/2022
- **Last updated:** 12/16/2022