Provider Demographics
NPI:1023264645
Name:KIDS DENTAL VILLAGE
Entity type:Organization
Organization Name:KIDS DENTAL VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-899-5437
Mailing Address - Street 1:39-05 61ST STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3566
Mailing Address - Country:US
Mailing Address - Phone:718-899-5437
Mailing Address - Fax:
Practice Address - Street 1:3905 61ST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3566
Practice Address - Country:US
Practice Address - Phone:718-899-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty