Provider Demographics
NPI:1538991666
Name:DRS HERAVI & KERMANSHAHCHIS' DENTAL CARE PC, INC
Entity type:Organization
Organization Name:DRS HERAVI & KERMANSHAHCHIS' DENTAL CARE PC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-616-4900
Mailing Address - Street 1:243 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4516
Mailing Address - Country:US
Mailing Address - Phone:516-616-4900
Mailing Address - Fax:516-282-2500
Practice Address - Street 1:243 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4516
Practice Address - Country:US
Practice Address - Phone:516-616-4900
Practice Address - Fax:516-282-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty