Provider Demographics
NPI:1174794432
Name:HOLLIS DENTAL CARE PC
Entity type:Organization
Organization Name:HOLLIS DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHAROUNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-423-9111
Mailing Address - Street 1:4741 HOLLIS COURT BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3944
Mailing Address - Country:US
Mailing Address - Phone:718-423-9111
Mailing Address - Fax:
Practice Address - Street 1:4741 HOLLIS COURT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3944
Practice Address - Country:US
Practice Address - Phone:718-423-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043257-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9176501OtherDORAL