Provider Demographics
NPI:1164682647
Name:ACCELLENT DENTAL P.C.
Entity Type:Organization
Organization Name:ACCELLENT DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-704-5358
Mailing Address - Street 1:3907 PRINCE ST
Mailing Address - Street 2:STE 3D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3907 PRINCE ST
Practice Address - Street 2:STE 3D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5399
Practice Address - Country:US
Practice Address - Phone:718-463-5268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY534841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02908698Medicaid