Provider Demographics
NPI:1639381916
Name:NAVALTA MAGSOMBOL, EDNA IBAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:IBAY
Last Name:NAVALTA MAGSOMBOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90-05 187TH PLACE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:718-217-7155
Mailing Address - Fax:718-361-5156
Practice Address - Street 1:37-11 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-361-5155
Practice Address - Fax:718-361-5156
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist