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General NPI Number Information
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NPI Number | 1205970332
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE DENTAL SERVICES OF NEW YORK PC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 173 E SHORE RD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11023-2415
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Country | US
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Telephone | 516-487-8110
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Fax | 516-487-8394
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Provider Business Mailing Address
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Address Line | 173 EAST SHORE RD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11023
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Country | US
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Telephone | 516-487-8110
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Fax | 516-487-8394
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH HARRIS EPSTEIN
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Credential | DDS
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Telephone | 516-487-8110
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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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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 34227
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 054882
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 054882
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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