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Contact Information

104 DENTAL, PLLC
10423 ROOSEVELT AVENUE
CORONA, NY11368-2327
 Phone: 718-426-3000
 Fax: 718-426-3002
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for 104 DENTAL, PLLC

NPI Number 1104356476
LBN Legal business name 104 DENTAL, PLLC
Authorized official ARTIN SAKHAEE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/19/2017
Last updated 07/21/2022 - About 4 years ago
Identifiers
NY License # 052701
NY Medicaid 052701
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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