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General NPI Number Information
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NPI Number | 1104217553
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Entity Type | Organization
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Legal Business Name | HAMPTON PEDIATRIC DENTAL
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 97 N MAIN ST
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-3300
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Country | US
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Telephone | 631-287-8687
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Fax |
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Provider Business Mailing Address
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Address Line | 97 N MAIN ST
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-3300
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Country | US
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Telephone | 631-287-8687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY COSENZA
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Credential |
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Telephone | 631-287-8687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 043391
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License Number State | NY
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