Organization
HQ DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL BORUCHOV DDS (OWNER)
(347) 283-2396
Entity
Organization
Contact information
Practice address
11620 QUEENS BLVD, FOREST HILLS, NY 11375-7055
(347) 283-2396
Mailing address
11620 QUEENS BLVD, FOREST HILLS, NY 11375-7055
(347) 283-2396
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
056907
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03718852
—
NY
Enumeration date
01/13/2014
Last updated
01/13/2014
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