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General NPI Number Information
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NPI Number | 1578524708
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Entity Type | Individual
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Provider Name | BENJAMIN FUNG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 253 MAIN ST
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City | NORTHPORT
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State | NY
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Zip | 11768-1730
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Country | US
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Telephone | 631-261-3533
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Fax | 631-261-3533
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Provider Business Mailing Address
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Address Line | 10 BUTTONWOOD DR
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City | DIX HILLS
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State | NY
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Zip | 11746-4803
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Country | US
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Telephone | 631-864-1670
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Fax | 631-261-3533
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046842
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License Number State | NY
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