Provider Demographics
NPI:1124018700
Name:CENTRO DENTAL FAMILIAR P.C
Entity Type:Organization
Organization Name:CENTRO DENTAL FAMILIAR P.C
Other - Org Name:CENTRO DENTAL FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:FILION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-533-7333
Mailing Address - Street 1:3742 90TH ST
Mailing Address - Street 2:FIRST FLOORR
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7830
Mailing Address - Country:US
Mailing Address - Phone:718-424-5559
Mailing Address - Fax:718-426-2484
Practice Address - Street 1:3742 90TH ST
Practice Address - Street 2:FIRST FLOORR
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7830
Practice Address - Country:US
Practice Address - Phone:718-424-5559
Practice Address - Fax:718-426-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01471503Medicaid