Provider Demographics
NPI:1194741546
Name:FOREST HILLS DENTAL ,P.C.
Entity type:Organization
Organization Name:FOREST HILLS DENTAL ,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-275-9792
Mailing Address - Street 1:10210 66TH RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2047
Mailing Address - Country:US
Mailing Address - Phone:718-275-9792
Mailing Address - Fax:718-997-8362
Practice Address - Street 1:10210 66TH RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2047
Practice Address - Country:US
Practice Address - Phone:718-275-9792
Practice Address - Fax:718-997-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01584454Medicaid