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General NPI Number Information
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NPI Number | 1295123537
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Entity Type | Organization
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Legal Business Name | STAT DENTAL PC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 4160 MERRICK ROAD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-795-7500
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Fax | 516-795-8102
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Provider Business Mailing Address
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Address Line | 4160 MERRICK ROAD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-795-7500
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Fax | 516-795-8102
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ERROL LADER
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Credential | DDS
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Telephone | 6315167957500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 030670-1
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License Number State | NY
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