Provider Demographics
NPI:1447557004
Name:CORONA FAMILY DENTAL P.C.
Entity Type:Organization
Organization Name:CORONA FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKLARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-507-1500
Mailing Address - Street 1:3731 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1979
Mailing Address - Country:US
Mailing Address - Phone:718-507-1500
Mailing Address - Fax:718-507-1755
Practice Address - Street 1:3731 103RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1952
Practice Address - Country:US
Practice Address - Phone:718-507-1500
Practice Address - Fax:718-507-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty