Healthcare Provider Details

I. General information

NPI: 1669531406
Provider Name (Legal Business Name): WAYNE THOMAS PRIGOFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN CITY PLZ SUITE 448
GARDEN CITY NY
11530-3302
US

IV. Provider business mailing address

300 GARDEN CITY PLZ SUITE 448
GARDEN CITY NY
11530-3302
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-4444
  • Fax:
Mailing address:
  • Phone: 516-746-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number037286-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: