Organization
82ND DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FARAMARZ KHALILI DDS (PRIMARY PROVIDER)
(718) 476-5555
Entity
Organization
Contact information
Practice address
8201 ROOSEVELT AVE, 2ND FLOOR, JACKSON HEIGHTS, NY 11372-7034
(718) 476-5555
(718) 476-6666
Mailing address
8201 ROOSEVELT AVE, 2ND FLOOR, JACKSON HEIGHTS, NY 11372-7034
(718) 476-5555
(718) 476-6666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01804719
—
NY
Enumeration date
09/29/2008
Last updated
09/29/2008
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