Organization
DYNAMIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM LUBLIN (CO-OWNER)
(718) 297-4100
Entity
Organization
Contact information
Practice address
17515 JAMAICA AVE, JAMAICA, NY 11432-5525
(718) 297-4100
(718) 297-4104
Mailing address
17515 JAMAICA AVE, JAMAICA, NY 11432-5525
(718) 297-4100
(718) 297-4104
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
032158
NY
1223G0001X
General Practice Dentistry
Primary
044929
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
051908
NY
124Q00000X
Dental Hygienist
022580
NY
124Q00000X
Dental Hygienist
031327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01980661
—
NY
Enumeration date
11/30/2010
Last updated
12/02/2010
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