Healthcare Provider Details

I. General information

NPI: 1386061083
Provider Name (Legal Business Name): DENTAL IMPLANT SOLUTIONS OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4334
US

IV. Provider business mailing address

639 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4334
US

V. Phone/Fax

Practice location:
  • Phone: 516-565-5656
  • Fax: 516-565-3391
Mailing address:
  • Phone: 516-565-5656
  • Fax: 516-565-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number52772
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number39888
License Number StateNY

VIII. Authorized Official

Name: ERIC D WEINSTEIN
Title or Position: OWNER
Credential: DDS
Phone: 516-565-6565