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General NPI Number Information
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NPI Number | 1437293560
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Entity Type | Organization
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Legal Business Name | STONY BROOK DENTAL ASSOCIATES
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/03/2007
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Provider Practice Location Address
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Address Line | STATE UNIVERSITY AT STONY BRK SCHOOL OF DENTAL MEDICINE 170 SULLIVAN HALL
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-632-8971
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Fax |
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Provider Business Mailing Address
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Address Line | STATE UNIVERSITY AT STONY BRK SCHOOL OF DENTAL MEDICINE 170 SULLIVAN HALL
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-632-8971
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ROBERT PHILIP REINER
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Credential | DMD
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Telephone | 631-444-2925
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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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