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General NPI Number Information
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NPI Number | 1053453084
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Entity Type | Individual
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Provider Name | MILES D. GORENKOFF D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 264 UNION AVE
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City | HOLBROOK
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State | NY
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Zip | 11741-1824
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Country | US
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Telephone | 631-588-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 11 THE GRASSLANDS
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City | WOODBURY
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State | NY
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Zip | 11797-1118
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 029051
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License Number State | NY
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