Organization
AESTHETICAREDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD REAZUL HAQUE D.D.S. (VICE PRESIDENT)
(917) 579-2194
Entity
Organization
Contact information
Practice address
21816 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1951
(917) 579-2194
Mailing address
21816 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1951
(917) 579-2194
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055217
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03283552
—
NY
Enumeration date
12/29/2011
Last updated
12/29/2011
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