Healthcare Provider Details

I. General information

NPI: 1992587505
Provider Name (Legal Business Name): FAMILY DENTIST OF GREAT NECK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MAPLE DR
GREAT NECK NY
11021-2049
US

IV. Provider business mailing address

17 MAPLE DR
GREAT NECK NY
11021-2049
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-2215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BIBI ABRAHIM
Title or Position: FINANCE MANAGER
Credential:
Phone: 718-445-7600