Provider Demographics
NPI:1861815730
Name:WHITESTONE PERIODONTICS AND DENTAL IMPLANTS PLLC
Entity Type:Organization
Organization Name:WHITESTONE PERIODONTICS AND DENTAL IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-423-4500
Mailing Address - Street 1:16032 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3905
Mailing Address - Country:US
Mailing Address - Phone:718-423-4500
Mailing Address - Fax:718-423-5268
Practice Address - Street 1:16032 20TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3905
Practice Address - Country:US
Practice Address - Phone:718-423-4500
Practice Address - Fax:718-423-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty