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General NPI Number Information
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NPI Number | 1336749530
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Entity Type | Organization
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Legal Business Name | SUFFOLK DENTAL CARE, PC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 3650 ROUTE 112 STE 105
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City | CORAM
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State | NY
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Zip | 11727-4131
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Country | US
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Telephone | 631-732-3400
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Fax | 631-732-3401
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Provider Business Mailing Address
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Address Line | 1040 1ST AVE # 393
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City | NEW YORK
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State | NY
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Zip | 10022-2991
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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 | DIRECTOR OF OPERATIONS
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Name | JOHANNY RODRIGUEZ
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Credential |
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Telephone | 917-583-5457
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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 |
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License Number State |
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