Provider Demographics
NPI:1184787061
Name:TEODORA R CONSTANTINESCU DDS PC
Entity type:Organization
Organization Name:TEODORA R CONSTANTINESCU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORA
Authorized Official - Middle Name:RODICA
Authorized Official - Last Name:CONSTANTINESCU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-821-5573
Mailing Address - Street 1:78 12 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2900
Mailing Address - Country:US
Mailing Address - Phone:718-821-5573
Mailing Address - Fax:718-381-3285
Practice Address - Street 1:78 12 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2900
Practice Address - Country:US
Practice Address - Phone:718-821-5573
Practice Address - Fax:718-381-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty