1629366703 NPI number — PEDIATRIC DENTAL WORLD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629366703 NPI number — PEDIATRIC DENTAL WORLD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC DENTAL WORLD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629366703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7228 BROADWAY
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-478-2825
Provider Business Mailing Address Fax Number:
718-478-2831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7228 BROADWAY
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-478-2825
Provider Business Practice Location Address Fax Number:
718-478-2831
Provider Enumeration Date:
07/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LARACUENTE
Authorized Official First Name:
DESIREE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-478-2825

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  053544 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com