Provider Demographics
NPI:1962289231
Name:GREEN GARDEN DENTAL PC
Entity type:Organization
Organization Name:GREEN GARDEN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHADID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-687-0014
Mailing Address - Street 1:8809 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1626
Mailing Address - Country:US
Mailing Address - Phone:718-429-7744
Mailing Address - Fax:718-429-7791
Practice Address - Street 1:8809 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1626
Practice Address - Country:US
Practice Address - Phone:718-429-7744
Practice Address - Fax:718-429-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental