| Bright White Dental, Pllc | |
|
18706 Union Tpke Fresh Meadows NY 11366-1705 | |
| (718) 730-9222 | |
| (718) 730-9117 |
| Full Name | Bright White Dental, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 18706 Union Tpke, Fresh Meadows, New York |
| Authorized Official Name and Position | Salamon Rafailov (DENTIST) |
| Authorized Official Contact | 7187309222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bright White Dental, Pllc 18706 Union Tpke Fresh Meadows NY 11366-1705 Ph: (718) 730-9222 | Bright White Dental, Pllc 18706 Union Tpke Fresh Meadows NY 11366-1705 Ph: (718) 730-9222 |
| NPI Number | 1568611937 |
|---|---|
| Provider Enumeration Date | 09/10/2008 |
| Last Update Date | 09/10/2008 |
| Medicare PECOS PAC ID | 2163959271 |
|---|---|
| Medicare Enrollment ID | O20250401002297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568611937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 053916 (New York) | Secondary |
| 1223G0001X | Dentist - General Practice | 052850 (New York) | Primary |
| Provider Name | Salamon Rafailov |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1093987018 PECOS PAC ID: 7719400688 Enrollment ID: I20250401002410 |
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