| Corona Pediatric Dental Plaza | |
|
10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 | |
| (718) 397-7000 | |
| Not Available |
| Full Name | Corona Pediatric Dental Plaza |
|---|---|
| Speciality | Dentist |
| Location | 10308 Roosevelt Ave, Corona, New York |
| Authorized Official Name and Position | Alicia A Pitkouvich (MANAGER) |
| Authorized Official Contact | 9173918000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corona Pediatric Dental Plaza 10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 Ph: (718) 397-7000 | Corona Pediatric Dental Plaza 10308 Roosevelt Ave 2nd Floor Corona NY 11368-2330 Ph: (718) 397-7000 |
| NPI Number | 1245632207 |
|---|---|
| Provider Enumeration Date | 09/22/2014 |
| Last Update Date | 09/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245632207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 055939 (New York) | Primary |
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