ROOSEVELT 26 DENTAL GROUP PLLC (NPI# 1407319239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407319239 |
| Entity Type | Organization |
| Organization Name | ROOSEVELT 26 DENTAL GROUP PLLC |
| Practice Address |
10308 Roosevelt Ave Corona NY 11368-2330 |
| Practice Telephone | 9173918000 |
| Mailing Telephone | 9173918000 |
| Mailing Fax Number | 7183978000 |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |
| Authorized Official Name | FARAMARZ KHALILI (OWNER) |
| Authorized Official Telephone | 5163828000 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03060184 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | ROOSEVELT 26 DENTAL GROUP PLLC | 27 Hickory Drive, Great Neck, Ny 11021 |
| Street Address |
10308 ROOSEVELT AVE |
| City | CORONA |
| State | NY |
| Zip Code | 11368-2330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699026385 | Corona Medical PC | Obstetrics & Gynecology | 10308 Roosevelt Ave, Second Floor, Corona, NY 11368-2330 | 2012-09-21 |
| 1245632207 | Corona 26 Dental Group | Dentist | 10308 Roosevelt Ave, 2nd Floor, Corona, NY 11368-2330 | 2014-09-22 |
| 1366886012 | Magdalena Goralczyk Endodontics Pllc | Dentist | 10308 Roosevelt Ave, Corona, NY 11368-2330 | 2013-04-24 |
| 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 | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629557517 | Ketcherside Dental Corporation | Dentist | 720 Magnolia Ave Ste A1, Corona, CA 92879-3119 | 2018-08-10 |
| 1952802878 | Garrett R. Kawata, Dds, Inc | Dentist | 854 Magnolia Ave Ste A, Corona, CA 92879-3109 | 2018-02-26 |
| 1023417029 | Hellosmile Orthodontics PC | Dentist | 103-24 Roosevelt Ave, Corona, NY 11368 | 2014-08-15 |
| 1912256678 | Roosevelt Orthodontics | Dentist | 4003 National St, Corona, NY 11368-2320 | 2012-09-09 |
| 1740422641 | Shital Patel D.d.s. & Rakesh Patel D.d.s., Inc | Dentist | 160 E Ontario Ave, Suite #103, Corona, CA 92879-3510 | 2009-03-24 |
| 1063617330 | Consumerhealth, Inc. | Dentist | 12636 Limonite Ave Ste 1a, Corona, CA 92880-4200 | 2007-06-18 |
| 1235150962 | Garrett Kawata | Dentist | 854 Magnolia Ave, Suite A, Corona, CA 92879-3109 | 2006-07-21 |
| 1033117965 | John K Pearson | Dentist | 910 Washburn Ave, Suite E, Corona, CA 92882-4348 | 2005-07-13 |
| 1003417627 | Timothy Yu | Dentist | 131 W Ontario Ave Ste 102, Corona, CA 92882-5274 | 2020-11-02 |
| 1629505417 | Ahmad Khan Dental Corp. | Dentist | 1530 W 6th St, Suite 101-a, Corona, CA 92882-2742 | 2017-05-11 |
| 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.