Healthcare Provider Details

I. General information

NPI: 1487715504
Provider Name (Legal Business Name): BABYLON DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 W MONTAUK HWY
WEST BABYLON NY
11704-8219
US

IV. Provider business mailing address

785 W MONTAUK HWY
WEST BABYLON NY
11704-8219
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-7373
  • Fax: 631-792-1985
Mailing address:
  • Phone: 631-587-7373
  • Fax: 631-792-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD R BROWN
Title or Position: OWNER
Credential: DDS
Phone: 631-587-7373