Organization
IDEAL SMILE DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YURI RESHETNIKOV DDS (OWNER)
(718) 205-2055
Entity
Organization
Contact information
Practice address
9123 QUEENS BLVD # B, ELMHURST, NY 11373-5531
(718) 205-2055
(718) 205-2355
Mailing address
PO BOX 740059, REGO PARK, NY 11374-0059
(718) 205-2055
(718) 205-2355
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
050616
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02457909
—
NY
Enumeration date
03/03/2014
Last updated
03/07/2023
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