Healthcare Provider Details

I. General information

NPI: 1114058666
Provider Name (Legal Business Name): GARDEN CITY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 7TH ST
GARDEN CITY NY
11530-2800
US

IV. Provider business mailing address

70 7TH ST
GARDEN CITY NY
11530-2800
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-7970
  • Fax:
Mailing address:
  • Phone: 516-741-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044925
License Number StateNY

VIII. Authorized Official

Name: DR. DENISE L EMMA
Title or Position: OWNER
Credential: D.D.S.
Phone: 516-741-7970