Provider Demographics
NPI:1952784464
Name:JAMAICA DENTAL PC
Entity Type:Organization
Organization Name:JAMAICA DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:YOUSEFNAJAD
Authorized Official - Last Name:KORORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-657-4838
Mailing Address - Street 1:9033 160TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6125
Mailing Address - Country:US
Mailing Address - Phone:718-657-0800
Mailing Address - Fax:718-657-0200
Practice Address - Street 1:90- 33, 166 STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-657-0800
Practice Address - Fax:718-657-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMMET DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty