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General NPI Number Information
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NPI Number | 1669280178
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Entity Type | Organization
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Legal Business Name | KOBAK & DIAMANTAKIS DDS PC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 590 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4522
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Country | US
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Telephone | 516-433-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 590 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR CREDENTIALING TEAM LEAD
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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