Organization
ROOSEVELT 26 DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARAMARZ KHALILI DDS (OWNER)
(516) 382-8000
Entity
Organization
Contact information
Practice address
10308 ROOSEVELT AVE, CORONA, NY 11368-2330
(917) 391-8000
Mailing address
10308 ROOSEVELT AVE, CORONA, NY 11368-2330
(917) 391-8000
(718) 397-8000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03060184
—
NY
Enumeration date
04/09/2019
Last updated
04/09/2019
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