Organization
DEBORAHNINADENTALOFFICEPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH NINA DDS (OWNER)
(718) 429-6622
Entity
Organization
Contact information
Practice address
9203 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7941
(718) 429-6622
(718) 429-6669
Mailing address
9203 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7941
(718) 429-6622
(718) 429-6669
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
048101-1
NY
122300000X
Dentist
055474-1
NY
1223G0001X
General Practice Dentistry
048800-1
NY
1223G0001X
General Practice Dentistry
Primary
050127-1
NY
1223G0001X
General Practice Dentistry
052578-1
NY
1223G0001X
General Practice Dentistry
055242-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02348667
—
NY
Enumeration date
02/21/2011
Last updated
01/09/2012
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