| Citidental | |
|
10149 Woodhaven Blvd Suite 2 Ozone Park NY 11416-2300 | |
| (718) 848-7722 | |
| Not Available |
| Full Name | Citidental |
|---|---|
| Speciality | Dentist |
| Location | 10149 Woodhaven Blvd, Ozone Park, New York |
| Authorized Official Name and Position | Marina Shraga (PRESIDENT) |
| Authorized Official Contact | 9177977272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Citidental 10149 Woodhaven Blvd Suite 2 Ozone Park NY 11416-2300 Ph: (718) 848-7722 | Citidental 10149 Woodhaven Blvd Suite 2 Ozone Park NY 11416-2300 Ph: (718) 848-7722 |
| NPI Number | 1811276926 |
|---|---|
| Provider Enumeration Date | 08/06/2011 |
| Last Update Date | 09/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811276926 | NPI | - | NPPES |
| 03307031 | Medicaid | NY | |
| 02721117 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 052174 (New York) | Primary |
| 122300000X | Dentist | 055124 (New York) | Secondary |
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