Provider Demographics
NPI:1013473339
Name:EMINENT DENTAL CARE P.C.
Entity Type:Organization
Organization Name:EMINENT DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-813-6105
Mailing Address - Street 1:16021 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1019
Mailing Address - Country:US
Mailing Address - Phone:347-813-6105
Mailing Address - Fax:
Practice Address - Street 1:25220 NORTHERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1344
Practice Address - Country:US
Practice Address - Phone:347-813-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty