Healthcare Provider Details

I. General information

NPI: 1417237280
Provider Name (Legal Business Name): RICHMOND HILL DENTAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 RICHMOND HILL RD
STATEN ISLAND NY
10314-5906
US

IV. Provider business mailing address

255 RICHMOND HILL RD
STATEN ISLAND NY
10314-5906
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-2010
  • Fax: 718-761-4743
Mailing address:
  • Phone: 718-494-2010
  • Fax: 718-761-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035401
License Number StateNY

VIII. Authorized Official

Name: DEAN M NEVID
Title or Position: OWNER
Credential: D.D.S.
Phone: 718-494-2010