| Sunrise Mall Dental Pc | |
|
380 Sunrise Mall Massapequa NY 11758 | |
| (516) 798-3444 | |
| (516) 798-3443 |
| Full Name | Sunrise Mall Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 380 Sunrise Mall, Massapequa, New York |
| Authorized Official Name and Position | Igor Levin (OWNER) |
| Authorized Official Contact | 5167983444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Mall Dental Pc 380 Sunrise Mall Massapequa NY 11758 Ph: (516) 798-3444 | Sunrise Mall Dental Pc 380 Sunrise Mall Massapequa NY 11758 Ph: (516) 798-3444 |
| NPI Number | 1619022944 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619022944 | NPI | - | NPPES |
| 02671561 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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