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Organization
QUEENS FAMILY DENTAL OFFICE PC
Active
Organization
QUEENS FAMILY DENTAL OFFICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRIA REYNOSO (PRESIDENT)
(718) 507-9100
Entity
Organization
Contact information
Practice address
9506 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-8029
(718) 507-9100
(718) 507-7377
Mailing address
9506 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-8029
(718) 507-9100
(718) 507-7377
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0465601
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01676782
—
NY
Enumeration date
03/20/2008
Last updated
03/20/2008
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