1376793414 NPI number — KINGS 26 DENTISTRY

Table of content: SHAQUILLE ALEXIS MERRITT RN (NPI 1558958041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376793414 NPI number — KINGS 26 DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGS 26 DENTISTRY
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:
1376793414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10504 CROSSBAY BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11417-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-843-4444
Provider Business Mailing Address Fax Number:
718-843-5097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10504 CROSSBAY BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11417-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-843-4444
Provider Business Practice Location Address Fax Number:
718-843-5097
Provider Enumeration Date:
09/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KHALILI
Authorized Official First Name:
FARAMARZ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRIMARY PROVIDER
Authorized Official Telephone Number:
718-843-4444

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  047305 , 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)

  • Identifier: 01804719 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com