Provider Demographics
NPI:1871232249
Name:QUEENBORO AND COURT SQUARE DENTAL ASSOCIATE, LLC
Entity type:Organization
Organization Name:QUEENBORO AND COURT SQUARE DENTAL ASSOCIATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISHWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-530-6539
Mailing Address - Street 1:2122 45TH RD APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27-21 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-530-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISHWINDER SARAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty