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General NPI Number Information
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NPI Number | 1760631402
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Entity Type | Organization
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Legal Business Name | ORTHODONTICS & PEDIATRIC ASSOC OF COMMACK
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 164 COMMACK RD STE 4
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 631-499-3377
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Fax | 631-858-0586
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Provider Business Mailing Address
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Address Line | 164 COMMACK RD STE 4
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 631-499-3377
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Fax | 631-858-0586
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Authorized Official
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Title or Position | DENTIST/PARTNER
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Name | DR. MONTE D. MILLER
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Credential | DMD
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Telephone | 631-499-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 048254
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License Number State | NY
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