Organization
GRAND SMILE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDRA KHAIMOV DDS (DENTIST)
(718) 255-1381
Entity
Organization
Contact information
Practice address
6977 GRAND AVE, MASPETH, NY 11378-1826
(718) 255-1381
(718) 255-1385
Mailing address
6977 GRAND AVE, MASPETH, NY 11378-1826
(718) 255-1381
(718) 255-1385
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
050666
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02408982
—
NY
Enumeration date
11/09/2012
Last updated
11/09/2012
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