Provider Demographics
NPI:1659354975
Name:ADVANCED QUALITY DENTAL HEALTH PC
Entity Type:Organization
Organization Name:ADVANCED QUALITY DENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMIANOU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-899-5309
Mailing Address - Street 1:4016 83RD ST
Mailing Address - Street 2:ADVANCED QUALITY DENTAL HEALTH PC
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1307
Mailing Address - Country:US
Mailing Address - Phone:718-899-5309
Mailing Address - Fax:718-899-5309
Practice Address - Street 1:4016 83RD ST
Practice Address - Street 2:ADVANCED QUALITY DENTAL HEALTH PC
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1307
Practice Address - Country:US
Practice Address - Phone:718-899-5309
Practice Address - Fax:718-899-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0016321OtherFIDELIS
NY01025290Medicaid
NY013611OtherDORAL