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Organization
WYCKOFF DENTAL PC
Active
Organization
WYCKOFF DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RUFINA LOUIS DDS (PRESIDENT)
(718) 386-3288
Entity
Organization
Contact information
Practice address
321 WYCKOFF AVENUE, RIDGEWOOD, NY 11385
(718) 386-3288
(718) 386-3540
Mailing address
321 WYCKOFF AVENUE, RIDGEWOOD, NY 11385
(718) 386-3288
(718) 386-3540
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
043062
—
261QD0000X
Dental Clinic/Center
02310121
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01812615
—
NY
05
—
02310121
—
NY
Enumeration date
02/01/2006
Last updated
12/28/2012
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