Healthcare Provider Details

I. General information

NPI: 1356568737
Provider Name (Legal Business Name): PETER R KAMPF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADHOLLOW RD STE 302
MELVILLE NY
11747-4901
US

IV. Provider business mailing address

150 BROADHOLLOW RD STE 302
MELVILLE NY
11747-4901
US

V. Phone/Fax

Practice location:
  • Phone: 631-315-1400
  • Fax: 516-677-0064
Mailing address:
  • Phone: 631-315-1400
  • Fax: 516-677-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number044122
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number044122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: