# CREATIVE DENTAL OF QUEENS

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

## Provider details

- **NPI number:** 1871981068
- **Authorized official:** TIMUR MOZNER D.D.S. (DENTIST)
- **Authorized official phone:** (718) 459-4700

## Contact information

- **Practice address:** 63-58 WETHEROLE STREET, REGO PARK, NY 11374
- **Practice address phone:** (718) 459-4700
- **Practice address fax:** (914) 390-9111
- **Mailing address:** 63-58 WETHEROLE STREET, REGO PARK, NY 11374
- **Mailing address phone:** (718) 459-4700
- **Mailing address fax:** (914) 390-9111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 048393 | NY | Yes |

## Other

- **Enumeration date:** 12/23/2014
- **Last updated:** 12/23/2014