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General NPI Number Information
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NPI Number | 1275059669
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Entity Type | Organization
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Legal Business Name | ROSLYN FAMILY DENTAL, P.C.
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 86 MINEOLA AVE
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577
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Country | US
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Telephone | 516-395-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 86 MINEOLA AVE
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ALLA HART
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Credential | D.D.S.
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Telephone | 516-395-5514
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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 | 058786
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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 | 046782-1
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License Number State | NY
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