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NPI Code Detail

MEDICARE: MILL POND DENTAL PC

MEDICARE: MILL POND DENTAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist038180NY

General Provider Information

NPI Number : 1285008771
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILL POND DENTAL PC
Provider Business Mailing Address
First Line : 1000 BROADWAY
Second Line :
City : WOODMERE
State : NY
Zip : 11598
Country : US
Telephone Number : 516-791-2200
Fax Number :
Provider Business Practice Location Address
First Line : 11 IRVING PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1256
Country : US
Telephone Number : 516-791-4000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. BARRY KENNETH ROZENBERG
Credential : DDS
Telephone Number : 516-791-4000
Provider Enumeration Date : 11/20/2015
Last Update Date : 05/30/2024

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