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215 Hallock Rd Suite 2 Stony Brook NY 11790-3078 | |
| (631) 689-3226 | |
| (631) 689-3155 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 215 Hallock Rd, Stony Brook, New York |
| Authorized Official Name and Position | Keith V Watkins (OWNER/DENTIST) |
| Authorized Official Contact | 6316893226 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
215 Hallock Road Suite 2 Stony Brook NY 11790-3078 Ph: (631) 689-3226 | 215 Hallock Rd Suite 2 Stony Brook NY 11790-3078 Ph: (631) 689-3226 |
| NPI Number | 1083898183 |
|---|---|
| Provider Enumeration Date | 12/26/2007 |
| Last Update Date | 12/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083898183 | NPI | - | NPPES |
| 02630335 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 034701 (New York) | Primary |
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