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General NPI Number Information
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NPI Number | 1154996577
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Entity Type | Organization
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Legal Business Name | GREAT NECK DENTAL PLLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 11 GRACE AVE STE 101
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City | GREAT NECK
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State | NY
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Zip | 11021-2417
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Country | US
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Telephone | 516-482-7566
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Fax |
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Provider Business Mailing Address
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Address Line | 87 ELDERD LN
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City | CEDARHURST
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State | NY
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Zip | 11516-2013
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Country | US
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Telephone | 516-239-1200
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOEL PREMINGER
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Credential | DMD
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Telephone | 516-482-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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