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General NPI Number Information
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NPI Number | 1851693196
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Entity Type | Organization
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Legal Business Name | DUGAN HILLS DENTAL PLLC
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 212 CROMWELL AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1308
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Country | US
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Telephone | 718-668-2900
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Fax | 718-928-9444
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Provider Business Mailing Address
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Address Line | 212 CROMWELL AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1308
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Country | US
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Telephone | 718-668-2900
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Fax | 718-928-9444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC ERIC WEBER
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Credential | DDS
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Telephone | 718-668-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50044210
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License Number State | NY
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