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General NPI Number Information
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NPI Number | 1801301833
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Entity Type | Organization
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Legal Business Name | HILLS PARK DENTAL
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 2053 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-2110
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Country | US
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Telephone | 631-254-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 2053 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-2110
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Country | US
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Telephone | 631-254-6596
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JAN TADDONIO
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Credential |
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Telephone | 631-254-6596
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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 | 52582
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License Number State | NY
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