Provider Demographics
NPI:1376765859
Name:JEFFREY CARRASQUILLO DMD PLLC
Entity Type:Organization
Organization Name:JEFFREY CARRASQUILLO DMD PLLC
Other - Org Name:JEFFREY CARRASQUILLO DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-261-0260
Mailing Address - Street 1:90-05 70TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-261-0260
Mailing Address - Fax:718-261-4742
Practice Address - Street 1:66-25 MAURICE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-651-5941
Practice Address - Fax:718-261-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty