Healthcare Provider Details

I. General information

NPI: 1871679696
Provider Name (Legal Business Name): HOWARD M TICHLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 MONTAUK HWY
WEST ISLIP NY
11795-4920
US

IV. Provider business mailing address

725 MONTAUK HWY
WEST ISLIP NY
11795-4920
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-6202
  • Fax: 631-661-7269
Mailing address:
  • Phone: 631-661-6202
  • Fax: 631-661-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number026145-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: