Provider Demographics
NPI:1033565122
Name:92 JAMAICA AVE DENTISTRY PC
Entity Type:Organization
Organization Name:92 JAMAICA AVE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KORORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-977-9230
Mailing Address - Street 1:9709 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2211
Mailing Address - Country:US
Mailing Address - Phone:917-776-7520
Mailing Address - Fax:
Practice Address - Street 1:9709 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2211
Practice Address - Country:US
Practice Address - Phone:917-776-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0491371261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental