Organization
IDEAL DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANAGIOTIS GLAVAS DDS (OWNER)
(516) 487-6453
Entity
Organization
Contact information
Practice address
800 NORTHERN BOULEVARD, SUITE #6, GREAT NECK, NY 11021
(516) 487-6453
Mailing address
800 NORTHERN BOULEVARD, SUITE #6, GREAT NECK, NY 11021
(516) 487-6453
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
047563
NY
1223G0001X
General Practice Dentistry
047563
NY
1223P0700X
Prosthodontics
047563
NY
Other
Enumeration date
04/05/2007
Last updated
04/30/2010
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