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General NPI Number Information
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NPI Number | 1285640755
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Entity Type | Organization
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Legal Business Name | DRS RANDALL W HIGHT DMD & DRS DAVID S TARICA DMD PC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1069 GREEN ACRES MALL
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City | VALLEY STREAM
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State | NY
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Zip | 11581
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Country | US
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Telephone | 516-568-2022
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Fax | 516-561-3907
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Provider Business Mailing Address
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Address Line | 1069 GREEN ACRES MALL
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City | VALLEY STREAM
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State | NY
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Zip | 11581
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Country | US
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Telephone | 516-568-2022
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Fax | 516-561-3907
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. RANDALL W HIGHT
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Credential | DMD
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Telephone | 516-568-2022
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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 | 037229
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License Number State | NY
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