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General NPI Number Information
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NPI Number | 1356766570
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE DENTISTRY PC
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 425 BROADHOLLOW RD SUITE 118
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City | MELVILLE
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State | NY
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Zip | 11747-4713
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Country | US
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Telephone | 631-752-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 425 BROADHOLLOW RD SUITE 118
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City | MELVILLE
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State | NY
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Zip | 11747-4713
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Country | US
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Telephone | 631-752-2929
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | FAINA BRAM
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Credential |
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Telephone | 631-752-2929
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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 | 0436971
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License Number State | NY
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