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General NPI Number Information
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NPI Number | 1184896912
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL PC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 362 W OLD COUNTRY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-4113
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Country | US
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Telephone | 516-933-3000
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Fax | 516-933-3001
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Provider Business Mailing Address
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Address Line | 362 W OLD COUNTRY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-4113
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Country | US
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Telephone | 516-933-3000
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Fax | 516-485-8386
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Authorized Official
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Title or Position | DENTIST
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Name | BERTHA DINA BRAVO
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Credential |
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Telephone | 516-933-3000
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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 | 044278
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License Number State | NY
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