Provider Demographics
NPI:1487935391
Name:ORAL AND MAXILLOFACIAL SURGERY OF QUEENS
Entity type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY OF QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-565-5005
Mailing Address - Street 1:3775 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3775 103RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1979
Practice Address - Country:US
Practice Address - Phone:718-565-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0518611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty