Healthcare Provider Details

I. General information

NPI: 1427642685
Provider Name (Legal Business Name): KRISTEN MARIE MCMAHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE GIUGLIANO

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH DRIVE SUNY AT STONY BROOK HOSPITAL DENTISTRY
STONY BROOK NY
11794-8711
US

IV. Provider business mailing address

SOUTH DRIVE SUNY AT STONY BROOK HOSPITAL DENTISTRY
STONY BROOK NY
11794-8711
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2557
  • Fax: 631-444-6013
Mailing address:
  • Phone: 631-444-2557
  • Fax: 631-444-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: