Organization
LIL PEARLS PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY FONG D.D.S. (MEMBER)
(516) 241-9760
Entity
Organization
Contact information
Practice address
94-11 65TH RD, SUITE 1B, REGO PARK, NY 11374
(347) 682-5688
Mailing address
94-11 65TH RD, SUITE 1B, REGO PARK, NY 11374
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
056689-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03634535
—
NY
Enumeration date
05/04/2015
Last updated
05/04/2015
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