Provider Demographics
NPI:1750475935
Name:ALLIANCE DENTAL P.C.
Entity Type:Organization
Organization Name:ALLIANCE DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VENIAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-424-7100
Mailing Address - Street 1:8411 NORTHERN BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1531
Mailing Address - Country:US
Mailing Address - Phone:718-424-7100
Mailing Address - Fax:718-424-7898
Practice Address - Street 1:8411 NORTHERN BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1531
Practice Address - Country:US
Practice Address - Phone:718-424-7100
Practice Address - Fax:718-424-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID