Provider Demographics
NPI:1730329004
Name:JACKSON HEIGHTS DENTAL GROUP
Entity type:Organization
Organization Name:JACKSON HEIGHTS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEROOKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-651-4523
Mailing Address - Street 1:85-09 37 AVENUE
Mailing Address - Street 2:BASEMENT
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-651-4523
Mailing Address - Fax:
Practice Address - Street 1:8509 37TH AVE
Practice Address - Street 2:BASEMENT
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7344
Practice Address - Country:US
Practice Address - Phone:718-651-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty