Provider Demographics
NPI:1588042949
Name:HARON DENTAL
Entity Type:Organization
Organization Name:HARON DENTAL
Other - Org Name:ELEMENTS DENTAL OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULLA
Authorized Official - Middle Name:SALAH
Authorized Official - Last Name:ZOOBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-777-9662
Mailing Address - Street 1:2836 STEINWAY ST
Mailing Address - Street 2:DENTAL OFFICE
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3332
Mailing Address - Country:US
Mailing Address - Phone:718-777-9662
Mailing Address - Fax:718-777-9682
Practice Address - Street 1:2836 STEINWAY ST
Practice Address - Street 2:DENTAL OFFICE
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3332
Practice Address - Country:US
Practice Address - Phone:718-777-9662
Practice Address - Fax:718-777-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053558305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization