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Organization
PRUDENT DENTAL CARE,P.C
Active
Organization
PRUDENT DENTAL CARE,P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYSORE SANATHKUMAR GANGA D.D.S (PRESIDENT)
(718) 803-6300
Entity
Organization
Contact information
Practice address
7517 41ST AVE, ELMHURST, NY 11373-1004
(718) 803-6300
(718) 803-2434
Mailing address
7517 41ST AVE, ELMHURST, NY 11373-1004
(718) 803-6300
(718) 803-2434
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
051064
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02489976
—
NY
Enumeration date
09/23/2010
Last updated
09/23/2010
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