Provider Demographics
NPI:1316092604
Name:MID QUEENS DENTAL & ASSOCIATES
Entity type:Organization
Organization Name:MID QUEENS DENTAL & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOURMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-426-2600
Mailing Address - Street 1:6059 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5416
Mailing Address - Country:US
Mailing Address - Phone:718-426-2600
Mailing Address - Fax:718-426-3072
Practice Address - Street 1:6059 83RD PL
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5416
Practice Address - Country:US
Practice Address - Phone:718-426-2600
Practice Address - Fax:718-426-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty