Provider Demographics
NPI:1346581410
Name:ALAVI-LIN DENTAL PC
Entity Type:Organization
Organization Name:ALAVI-LIN DENTAL PC
Other - Org Name:WOODSIDE SPECIALTY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-713-9588
Mailing Address - Street 1:5123 QUEENS BLVD
Mailing Address - Street 2:OFFICE 1, DENTIST
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4587
Mailing Address - Country:US
Mailing Address - Phone:718-440-9272
Mailing Address - Fax:718-440-9797
Practice Address - Street 1:5123 QUEENS BLVD
Practice Address - Street 2:OFFICE 1, DENTIST
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4587
Practice Address - Country:US
Practice Address - Phone:718-440-9272
Practice Address - Fax:718-440-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055123261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03362672Medicaid