Provider Demographics
NPI:1407133523
Name:EXQUISITE DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:EXQUISITE DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-229-9100
Mailing Address - Street 1:4522 LITTLE NECK PKWY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1456
Mailing Address - Country:US
Mailing Address - Phone:718-229-9100
Mailing Address - Fax:718-229-9109
Practice Address - Street 1:4522 LITTLE NECK PKWY
Practice Address - Street 2:SUITE #2
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1456
Practice Address - Country:US
Practice Address - Phone:718-229-9100
Practice Address - Fax:718-229-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03102967Medicaid