Provider Demographics
NPI:1750609574
Name:NINA LARACUENTE DMD P.C.
Entity type:Organization
Organization Name:NINA LARACUENTE DMD P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-313-0613
Mailing Address - Street 1:3255 83RD ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-2007
Mailing Address - Country:US
Mailing Address - Phone:718-313-0613
Mailing Address - Fax:718-535-7815
Practice Address - Street 1:3255 83RD ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-2007
Practice Address - Country:US
Practice Address - Phone:718-313-0613
Practice Address - Fax:718-535-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN