Provider Demographics
NPI:1649573197
Name:TCN DENTAL CARE P.C.
Entity Type:Organization
Organization Name:TCN DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALOMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-523-8400
Mailing Address - Street 1:16110 JAMAICA AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6149
Mailing Address - Country:US
Mailing Address - Phone:718-523-8400
Mailing Address - Fax:718-523-0565
Practice Address - Street 1:16110 JAMAICA AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6149
Practice Address - Country:US
Practice Address - Phone:718-523-8400
Practice Address - Fax:718-523-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054092261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699921437Medicaid