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General NPI Number Information
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NPI Number | 1114936929
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Entity Type | Organization
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Legal Business Name | WANTAGH DENTAL ARTS, PC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1228 WANTAGH AVE SUITE 102
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City | WANTAGH
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State | NY
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Zip | 11793-2209
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Country | US
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Telephone | 516-679-7978
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Fax | 516-826-5830
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Provider Business Mailing Address
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Address Line | PO BOX 7485
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City | WANTAGH
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State | NY
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Zip | 11793-0485
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Country | US
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Telephone | 516-679-7978
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Fax | 516-826-5830
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRYAN R HOERTDOERFER
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Credential | DDS
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Telephone | 516-679-7978
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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 | 044865
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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 | 051494
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 049186
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 016591
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 022088
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License Number State | NY
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