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General NPI Number Information
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NPI Number | 1265602874
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Entity Type | Organization
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Legal Business Name | STONY BROOK DENTAL ASSOCIATES
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | SULLIVAN HALL ROOM 170 FACULTY PRACTICE
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City | STONY BROOK
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State | NY
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Zip | 11794-8705
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Country | US
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Telephone | 631-632-8971
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Fax | 631-632-7658
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Provider Business Mailing Address
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Address Line | SULLIVAN HALL ROOM 170 FACULTY PRACTICE
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City | STONY BROOK
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State | NY
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Zip | 11794-8705
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Country | US
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Telephone | 631-632-8971
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Fax | 631-632-7658
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ROBERT REINER
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Credential | D.D.S
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Telephone | 631-632-8971
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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 | 043965-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 031804-1
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License Number State | NY
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