Organization
ASTORIA DENTAL BROADWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW MARON DDS (OWNER)
(929) 522-0554
Entity
Organization
Contact information
Practice address
31-72 31ST ST, SUITE #1, ASTORIA, NY 11106
(929) 522-0554
Mailing address
31-72 31ST ST, SUITE #1, ASTORIA, NY 11106
(929) 522-0554
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
043641
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215035134
TYPE 2
—
Enumeration date
07/09/2018
Last updated
07/09/2018
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