Provider Demographics
NPI:1639570278
Name:APEX DENTAL, PC
Entity Type:Organization
Organization Name:APEX DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-497-9700
Mailing Address - Street 1:7407 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7433
Mailing Address - Country:US
Mailing Address - Phone:718-497-9700
Mailing Address - Fax:
Practice Address - Street 1:7407 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7433
Practice Address - Country:US
Practice Address - Phone:718-497-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527991223S0112X
NY051170-11223S0112X
NY049449-11223S0112X
NY052602125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No125J00000XDental ProvidersDental TherapistGroup - Single Specialty