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General NPI Number Information
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NPI Number | 1831699347
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Entity Type | Organization
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Legal Business Name | WHITEHALL DENTAL ARTS PLLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 520 FRANKLIN AVE STE 126
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City | GARDEN CITY
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State | NY
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Zip | 11530-5876
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Country | US
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Telephone | 516-554-3346
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Fax |
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Provider Business Mailing Address
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Address Line | 25 KENSINGTON RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-4240
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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 | OWNER / DENTIST
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Name | JAIME BREMNES
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Credential | DMD
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Telephone | 516-554-3346
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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 | 054015
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License Number State | NY
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