104 DENTAL, PLLC (NPI# 1104356476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104356476 |
| Entity Type | Organization |
| Organization Name | 104 DENTAL, PLLC |
| Practice Address |
10423 Roosevelt Avenue Corona NY 11368-2327 |
| Practice Telephone | (718) 426-3000 |
| Practice Fax Number | 7184263002 |
| Mailing Telephone | 7184263000 |
| Mailing Fax Number | 7184263002 |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2019-06-03 |
| Authorized Official Name | DR. ARTIN SAKHAEE (OWNER) |
| Authorized Official Telephone | 7184767801 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
052701 | NY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 052701 | 05 |
| Street Address |
10423 ROOSEVELT AVENUE |
| City | CORONA |
| State | NY |
| Zip Code | 11368-2327 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760014039 | Marukh Naeem | Behavioral Analyst | 11119a Roosevelt Ave, Apt 2r, Apt 2r, Corona, NY 11368 | 2020-02-05 |
| 1164072989 | Tonyia Michelle Madison | Counselor | 34-10 108 Street, Corona, Queens, NY 11368 | 2019-09-13 |
| 1962987347 | Sinead Anel Ulloa | Speech-Language Pathologist | 10420 37th Rd, Corona, NY 11368 | 2018-10-01 |
| 1245725779 | Bracha Namdar | Optometrist | 103-06 Roosevelt Ave, Corona, NY 11368 | 2018-06-27 |
| 1548758220 | Karina Elizabeth Carrasco | Specialist | 96- 32 46th Ave, Corona, NY 11368 | 2018-04-27 |
| 1134634033 | Nicole Iuculano | Speech-Language Pathologist | 43-18 97th Place, Corona, NY 11368 | 2017-12-13 |
| 1558880831 | Abenaa Nyame Danquah | Registered Nurse | 55-25 98th Place, Apt 1k, Corona, NY 11368 | 2017-09-18 |
| 1063940443 | Brand Rx Pharmacy Corp | Pharmacy | 97-05 A 57th Avenue, Corona, NY 11368 | 2017-05-30 |
| 1427595909 | Richelle Krish Sumaoy Colmenares | Physical Therapist | 3744 104th St., Corona, New York City, NY 11368 | 2017-01-23 |
| 1235674342 | 39th Avenue Physical Therapy PC | Clinic/Center | 103-18c 39 Ave, Corona, NY 11368 | 2016-12-28 |
| Find all providers in zip 11368 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811530488 | Adria Marcinkowski | Dentist | 13100 Magnolia Ave Ste B, Corona, CA 92879-5365 | 2019-10-25 |
| 1972155877 | Timothy Rhee Dds Professional Corporation | Dentist | 260 E Ontario Ave Ste 205, Corona, CA 92879-3507 | 2019-07-10 |
| 1639731888 | Trevor Thomas Dental Corporation | Dentist | 460 N Mckinley St Ste 101, Corona, CA 92879-3405 | 2019-07-08 |
| 1437642220 | Cesar Steven Quezada | Dentist | 5530 99th St, Corona, NY 11368-3745 | 2018-06-07 |
| 1013453794 | Vasoya Dipakkumar Dds PC | Dentist | 301 W 6th St Ste 105, Corona, CA 92882-3304 | 2017-01-18 |
| 1003363243 | Juan Gerardo Martinez | Dentist | 490 N Main St Ste 207, Corona, CA 92878-3461 | 2016-09-06 |
| 1073965869 | Gerri Blick | Dentist | 10324 Roosevelt Ave Fl 2, Corona, NY 11368 | 2016-07-06 |
| 1316391303 | Michael I Saed | Dentist | 1074 W 6th St Ste 104, Corona, CA 92882-1639 | 2016-04-16 |
| 1760846950 | Rocio Palomino | Dentist | 3809 Junction Blvd Fl 2, Corona, NY 11368-2153 | 2016-04-13 |
| 1619330750 | Jalpa Patel, Dds, Inc | Dentist | 1380 W 6th St, Suite 103, Corona, CA 92882-3552 | 2016-04-05 |
| Find all providers in CORONA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.