Provider Demographics
NPI:1912761313
Name:FAMILY DENTIST OF LITTLE NECK PLLC
Entity Type:Organization
Organization Name:FAMILY DENTIST OF LITTLE NECK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-445-7600
Mailing Address - Street 1:6004 MARATHON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2000
Mailing Address - Country:US
Mailing Address - Phone:718-225-4433
Mailing Address - Fax:
Practice Address - Street 1:6004 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2000
Practice Address - Country:US
Practice Address - Phone:718-225-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty