Individual
JEFFREY CARRASQUILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6625 MAURICE AVE, WOODSIDE, NY 11377-7536
(718) 651-5941
(718) 261-4742
Mailing address
6625 MAURICE AVE, WOODSIDE, NY 11377-7536
(718) 651-5941
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
045010
NY
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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