Healthcare Provider Details

I. General information

NPI: 1740166677
Provider Name (Legal Business Name): BRUSH HOLLOW DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 BRUSH HOLLOW RD STE 100
WESTBURY NY
11590-1779
US

IV. Provider business mailing address

959 BRUSH HOLLOW RD STE 100
WESTBURY NY
11590-1779
US

V. Phone/Fax

Practice location:
  • Phone: 516-518-7335
  • Fax: 516-550-7580
Mailing address:
  • Phone: 516-518-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ERIN DIAMANTAKIS
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 516-518-7335