Provider Demographics
NPI:1851549075
Name:PLEASANT DENTAL PLLC
Entity Type:Organization
Organization Name:PLEASANT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WOOJUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-368-4237
Mailing Address - Street 1:19402 NORTHERN BLVD
Mailing Address - Street 2:SUITE# LL1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3002
Mailing Address - Country:US
Mailing Address - Phone:347-368-4237
Mailing Address - Fax:347-438-1849
Practice Address - Street 1:19402 NORTHERN BLVD
Practice Address - Street 2:SUITE# LL1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3002
Practice Address - Country:US
Practice Address - Phone:347-368-4237
Practice Address - Fax:347-438-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711053Medicaid