Provider Demographics
NPI:1275839763
Name:NORTH FLUSHING DENTAL MANAGEMENT
Entity Type:Organization
Organization Name:NORTH FLUSHING DENTAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIRAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHMUELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-762-0202
Mailing Address - Street 1:13336 WHITESTONE EXPY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2509
Mailing Address - Country:US
Mailing Address - Phone:718-462-0202
Mailing Address - Fax:
Practice Address - Street 1:13336 WHITESTONE EXPY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2509
Practice Address - Country:US
Practice Address - Phone:718-462-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0435251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty