Beridze, Revaz

Beridze, Revaz is an individual health care provider with primary practice located at 10440 Queens Blvd #1Y, Forest Hills NY 11375-3658. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Beridze, Revaz can be contacted via phone (718) 459-3159.

Contact Information

Primary practice address
10440 Queens Blvd #1Y Forest Hills NY 11375-3658
Phone: (718) 459-3159
Fax: (718) 459-3148
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 046224-1 New York

Profile Details

NPI number 1073642823
LBN Legal business name Beridze, Revaz
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 5th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073642823 NPPES
New York MEDICAID 01616279

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