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General NPI Number Information
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NPI Number | 1386101921
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Entity Type | Organization
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Legal Business Name | PROHEALTH DENTAL PLLC
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 100 MERRICK RD STE 106E
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4801
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Country | US
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Telephone | 516-766-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MERRICK RD STE 106E
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4801
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Country | US
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Telephone | 516-766-5558
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | NEIL R KARNOFSKY
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Credential |
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Telephone | 212-969-9999
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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