104 Dental, PLLC
Organization Active NPI General Practice Dentistry · Corona, NY
NPI 1104356476 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1104356476
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 052701 (NY)
- Legal business name
- 104 DENTAL, PLLC
- Practice address
- 10423 Roosevelt Avenue
Corona, NY 11368-2327 - Phone
- (718) 426-3000
- Fax
- (718) 426-3002
- NPI assigned
- Jun 19, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Artin Sakhaee, DDS
- Title
- Owner
- Phone
- (718) 476-7801
Practitioners 1
-
Alexandra Ames, DDS
National Provider Directory
Locations
10423 Roosevelt Ave
Corona, NY 11368
Phone (718) 426-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 052701 | NY | Yes |
Addresses
Primary practice location
10423 Roosevelt Avenue
Corona, NY 11368-2327
Mailing address
10423 Roosevelt Avenue
Corona, NY 11368-2327
Phone (718) 426-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052701 | Medicaid | NY |
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All providers in Corona, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.