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General NPI Number Information
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NPI Number | 1881670883
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Entity Type | Organization
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Legal Business Name | GLEN R. KREITZBERG D.D.S.,P.C.
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 353 VETERANS MEMORIAL HWY SUITE 202
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City | COMMACK
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State | NY
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Zip | 11725-4200
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Country | US
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Telephone | 631-543-5555
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Fax | 631-543-5556
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Provider Business Mailing Address
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Address Line | 353 VETERANS MEMORIAL HWY SUITE 202
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City | COMMACK
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State | NY
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Zip | 11725-4233
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Country | US
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Telephone | 631-543-5555
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Fax | 631-543-5556
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLEN RICHARD KREITZBERG
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Credential | D.D.S.
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Telephone | 631-543-5555
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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 | 036804
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License Number State | NY
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