Healthcare Provider Details

I. General information

NPI: 1013359777
Provider Name (Legal Business Name): MARTIN R BOORIN, DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 WESTMINSTER AVE
DIX HILLS NY
11746-6340
US

IV. Provider business mailing address

PO BOX 107
HUNTINGTON STATION NY
11746-0089
US

V. Phone/Fax

Practice location:
  • Phone: 516-776-0716
  • Fax: 631-940-7227
Mailing address:
  • Phone: 631-940-3690
  • Fax: 631-940-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number039997
License Number StateNY

VIII. Authorized Official

Name: MARTIN R BOORIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 631-940-3690