Provider Demographics
NPI:1720109390
Name:MZIA KRIKHELY DDS PC
Entity Type:Organization
Organization Name:MZIA KRIKHELY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MZIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRIKHELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-544-2424
Mailing Address - Street 1:111 17A QWEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-2424
Mailing Address - Fax:718-544-2428
Practice Address - Street 1:111 17A QWEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-544-2424
Practice Address - Fax:718-544-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01262500Medicaid