Provider Demographics
NPI:1073059283
Name:YANDRESCO QUINTANA DDS PC
Entity Type:Organization
Organization Name:YANDRESCO QUINTANA DDS PC
Other - Org Name:NEW HEIGHTS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANDRESCO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:212-927-0565
Mailing Address - Street 1:245 E 93RD ST APT 21A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3960
Mailing Address - Country:US
Mailing Address - Phone:212-927-0565
Mailing Address - Fax:
Practice Address - Street 1:651 W 180TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4802
Practice Address - Country:US
Practice Address - Phone:212-927-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057383261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery