Organization
GRAND DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FLORA ANGELA CHAVEZ-ROMERO DDS (PRESIDENT)
(516) 378-1968
Entity
Organization
Contact information
Practice address
2000 GRAND AVE, NORTH BALDWIN, NY 11510-2811
(516) 378-1968
(516) 608-9319
Mailing address
2000 GRAND AVE, NORTH BALDWIN, NY 11510-2811
(516) 378-1968
(516) 608-9319
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
046215
NY
1223P0700X
Prosthodontics
052129
NY
124Q00000X
Dental Hygienist
P82633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01588090
—
NY
05
—
01627467
—
NY
05
—
02826084
—
NY
Enumeration date
12/13/2011
Last updated
03/22/2012
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