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General NPI Number Information
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NPI Number | 1043216435
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Entity Type | Individual
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Provider Name | MARTIN R. BOORIN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 1087 WESTMINSTER AVE
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City | DIX HILLS
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State | NY
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Zip | 11746-6340
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Country | US
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Telephone | 516-776-0716
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Fax | 631-940-7227
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Provider Business Mailing Address
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Address Line | P.O. BOX 107
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746
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Country | US
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Telephone | 631-940-3690
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Fax | 631-940-7227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 039997
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DIO1606400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7066
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 039997
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 7006
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 220101606400
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License Number State | NJ
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