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General NPI Number Information
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NPI Number | 1962268144
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Entity Type | Organization
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Legal Business Name | HUNTINGTON STATION DENTAL
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 135 W JERICHO TPKE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-3649
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Country | US
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Telephone | 317-918-7075
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W JERICHO TPKE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-3649
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Country | US
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Telephone | 317-918-7075
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN SEO
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Credential | DDS
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Telephone | 317-918-7075
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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 |
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License Number State |
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