| Cloudlake Dental Pllc | |
|
400 N Broadway Jericho NY 11753-2113 | |
| (516) 992-6340 | |
| Not Available |
| Full Name | Cloudlake Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 400 N Broadway, Jericho, New York |
| Authorized Official Name and Position | Kunal Saggar (MANAGING MEMBER) |
| Authorized Official Contact | 5169926340 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cloudlake Dental Pllc 400 N Broadway Jericho NY 11753-2113 Ph: (516) 992-6340 | Cloudlake Dental Pllc 400 N Broadway Jericho NY 11753-2113 Ph: (516) 992-6340 |
| NPI Number | 1912444050 |
|---|---|
| Provider Enumeration Date | 01/27/2017 |
| Last Update Date | 01/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912444050 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 056153 (New York) | Primary |
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Jack Casale D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 N Broadway, Jericho, NY 11753 Phone: 516-822-5757 | |
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