Provider Demographics
NPI:1013184613
Name:QUISQUEYA DENTAL PC
Entity Type:Organization
Organization Name:QUISQUEYA DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILADYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-847-8807
Mailing Address - Street 1:113-10 JAMAICA AVE
Mailing Address - Street 2:1 FL
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2440
Mailing Address - Country:US
Mailing Address - Phone:718-847-8807
Mailing Address - Fax:718-847-9464
Practice Address - Street 1:113-10 JAMAICA AVE
Practice Address - Street 2:1 FL
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2440
Practice Address - Country:US
Practice Address - Phone:718-847-8807
Practice Address - Fax:718-847-9464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUISQUEYA DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0449861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439427Medicaid