104 DENTAL, PLLC

NPI: 1104356476 · Organization · Active

Primary Specialty

General Practice Dentistry
Dentist — General Practice

Practice Location

10423 ROOSEVELT AVENUE
CORONA, NY 11368-2327 Map ↗
Phone: 718-426-3000
Fax: 718-426-3002

All Specialties & Licenses

  • General Practice Dentistry Primary — General Practice (license: 052701, NY)

NPI Registration

Enumerated: 2017-06-19

Last CMS Update: 2022-07-21