| Island Orthodontic,pllc | |
|
500 Portion Rd Lake Ronkonkoma NY 11779-4587 | |
| (631) 588-1199 | |
| Not Available |
| Full Name | Island Orthodontic,pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 500 Portion Rd, Lake Ronkonkoma, New York |
| Authorized Official Name and Position | Scott Friedman (MEMBER) |
| Authorized Official Contact | 6315881199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Orthodontic,pllc 500 Portion Rd Lake Ronkonkoma NY 11779-4587 Ph: (631) 588-1199 | Island Orthodontic,pllc 500 Portion Rd Lake Ronkonkoma NY 11779-4587 Ph: (631) 588-1199 |
| NPI Number | 1558439844 |
|---|---|
| Provider Enumeration Date | 12/03/2006 |
| Last Update Date | 03/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558439844 | NPI | - | NPPES |
| 01076008 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 034366 (New York) | Primary |
Sachem Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 469 Hawkins Ave, Suite 101, Lake Ronkonkoma, NY 11779 Phone: 631-588-8280 Fax: 631-588-6258 |