Provider Demographics
NPI:1376799510
Name:AUSTIN DENTAL CARE
Entity Type:Organization
Organization Name:AUSTIN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARANAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-544-4440
Mailing Address - Street 1:7017 AUSTIN ST
Mailing Address - Street 2:#3D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4722
Mailing Address - Country:US
Mailing Address - Phone:718-544-4440
Mailing Address - Fax:718-233-2723
Practice Address - Street 1:7017 AUSTIN ST
Practice Address - Street 2:#3D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4722
Practice Address - Country:US
Practice Address - Phone:718-544-4440
Practice Address - Fax:718-233-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117742Medicaid
NY02374876Medicaid