Provider Demographics
NPI:1326550302
Name:FLUSHING ORAL SURGERY - DENTAL IMPLANTS
Entity Type:Organization
Organization Name:FLUSHING ORAL SURGERY - DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:347-943-1960
Mailing Address - Street 1:14238 37TH AVE UNIT 1G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4103
Mailing Address - Country:US
Mailing Address - Phone:347-943-1960
Mailing Address - Fax:347-943-1961
Practice Address - Street 1:14238 37TH AVE UNIT 1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4103
Practice Address - Country:US
Practice Address - Phone:347-943-1960
Practice Address - Fax:347-943-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental