104 DENTAL, PLLC
Organization (NPI-2)
Active
Dentist, General Practice
Provider Information
- NPI Number
1104356476- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 10423 ROOSEVELT AVENUE, CORONA, NY, 113682327
- Phone
- (718) 426-3000
- Fax
- (718) 426-3002
Specialties & Taxonomies
Dentist, General Practice
Primary License: NY #052701