Provider Demographics
NPI:1053025007
Name:AL DENTE DENTAL OF ROSLYN, P.C.
Entity type:Organization
Organization Name:AL DENTE DENTAL OF ROSLYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALOMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-499-5393
Mailing Address - Street 1:70 GLEN COVE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1729
Mailing Address - Country:US
Mailing Address - Phone:516-499-5393
Mailing Address - Fax:516-499-5393
Practice Address - Street 1:70 GLEN COVE RD STE 103
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1729
Practice Address - Country:US
Practice Address - Phone:516-499-5393
Practice Address - Fax:516-499-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty