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General NPI Number Information
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NPI Number | 1356771307
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Entity Type | Organization
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Legal Business Name | RIVERHEAD DENTAL ASSOC. P.C.
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 960 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2734
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Country | US
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Telephone | 631-740-9050
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Fax | 631-740-9053
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Provider Business Mailing Address
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Address Line | 960 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2734
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Country | US
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Telephone | 631-740-9050
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Fax | 631-740-9053
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN SHEREN
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Credential | D.D.S.
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Telephone | 631-740-9050
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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 | 046780
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License Number State | NY
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