Healthcare Provider Details

I. General information

NPI: 1093982274
Provider Name (Legal Business Name): HAMPTON FAMILY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MONTAUK HWY
EAST QUOGUE NY
11942-3917
US

IV. Provider business mailing address

421 MONTAUK HWY
EAST QUOGUE NY
11942-3917
US

V. Phone/Fax

Practice location:
  • Phone: 631-653-5888
  • Fax: 631-653-7813
Mailing address:
  • Phone: 631-653-5888
  • Fax: 631-653-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04185402
License Number StateNY

VIII. Authorized Official

Name: MRS. LORRAINE RICHTER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 631-653-5888