Organization
ELITE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL ISAKHAROV DDS (SOLE PROPRIETOR)
(718) 897-9745
Entity
Organization
Contact information
Practice address
9819 64TH AVE APT 1H, REGO PARK, NY 11374-2525
(718) 897-9745
Mailing address
9819 64TH AVE APT 1H, REGO PARK, NY 11374-2525
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049803
NY
Other
Enumeration date
07/28/2008
Last updated
07/28/2008
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