Provider Demographics
NPI:1871743757
Name:QUEENS FAMILY DENTAL
Entity type:Organization
Organization Name:QUEENS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ELIADES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-278-5700
Mailing Address - Street 1:2602 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3123
Mailing Address - Country:US
Mailing Address - Phone:718-278-5700
Mailing Address - Fax:718-278-5794
Practice Address - Street 1:2602 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3123
Practice Address - Country:US
Practice Address - Phone:718-278-5700
Practice Address - Fax:718-278-5794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEENS FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY375401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty