Provider Demographics
NPI:1467672055
Name:KINGS DENTISTRY PC
Entity Type:Organization
Organization Name:KINGS DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:FEREYDOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:INDRA
Authorized Official - Phone:718-827-6001
Mailing Address - Street 1:1176 LIBERTY AVE # 2FL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3309
Mailing Address - Country:US
Mailing Address - Phone:718-827-6001
Mailing Address - Fax:718-277-3938
Practice Address - Street 1:1176 LIBERTY AVE # 2FL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3309
Practice Address - Country:US
Practice Address - Phone:718-827-6001
Practice Address - Fax:718-277-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty