Healthcare Provider Details

I. General information

NPI: 1750434809
Provider Name (Legal Business Name): SPECIALTY DENTAL OF GREENPOINT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NORMAN AVE
BROOKLYN NY
11222-2934
US

IV. Provider business mailing address

92 NORMAN AVE
BROOKLYN NY
11222-2934
US

V. Phone/Fax

Practice location:
  • Phone: 718-383-0933
  • Fax: 718-349-0930
Mailing address:
  • Phone: 718-383-0933
  • Fax: 718-349-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034744
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0522391
License Number StateNY

VIII. Authorized Official

Name: DR. CHARLES J PTAK JR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 718-383-0933