Provider Demographics
NPI:1942623301
Name:ATLANTIS DENTISTRY PC
Entity Type:Organization
Organization Name:ATLANTIS DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-921-2374
Mailing Address - Street 1:10232 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2009
Mailing Address - Country:US
Mailing Address - Phone:718-805-6000
Mailing Address - Fax:718-805-1400
Practice Address - Street 1:10232 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2009
Practice Address - Country:US
Practice Address - Phone:718-805-6000
Practice Address - Fax:718-805-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050721261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental