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General NPI Number Information
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NPI Number | 1679944037
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Entity Type | Individual
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Provider Name | WILLER CONSTANT DDS
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Gender | Male
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 6200 BEACH CHANNEL DR
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City | ARVERNE
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State | NY
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Zip | 11692-1409
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Country | US
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Telephone | 718-945-7150
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Fax | 718-945-2596
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Provider Business Mailing Address
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Address Line | 1200 E 53RD ST APT 5Y
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City | BROOKLYN
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State | NY
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Zip | 11234-2344
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Country | US
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Telephone | 347-393-7909
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 058259-1
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License Number State | NY
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