Individual
MRS. JUANA X MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
10105 77 ST, OZONE PAARK, NY 11416
(718) 323-1288
(718) 323-0291
Mailing address
10105 77TH ST, OZONE PARK, NY 11416-1904
(718) 323-1288
(718) 323-0291
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0457981
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01558754
—
NY
Enumeration date
01/12/2007
Last updated
07/08/2007
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