Provider Demographics
NPI:1053788380
Name:ASTORIA DENTAL DESIGN LLC
Entity type:Organization
Organization Name:ASTORIA DENTAL DESIGN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVRATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-579-5159
Mailing Address - Street 1:15043 14TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1817
Mailing Address - Country:US
Mailing Address - Phone:212-572-9800
Mailing Address - Fax:347-436-9569
Practice Address - Street 1:15043 14TH AVE
Practice Address - Street 2:STE C
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1817
Practice Address - Country:US
Practice Address - Phone:212-572-9800
Practice Address - Fax:347-436-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051604-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty