Organization
CORONA 26 DENTAL GROUP
Active
Other names
Corona Pediatric Dental Plaza
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA A PITKOUVICH (MANAGER)
(917) 391-8000
Entity
Organization
Contact information
Practice address
10308 ROOSEVELT AVE, 2ND FLOOR, CORONA, NY 11368-2330
(718) 397-7000
Mailing address
10308 ROOSEVELT AVE, 2ND FLOOR, CORONA, NY 11368-2330
(718) 397-7000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055939
NY
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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