Suffolk Dental Care, PC
Dentist in Coram, NY. Organization (NPI-2).
NPI number1336749530
StatusActive
Last updated in NPPESOct 27, 2020
Details
- NPI
- 1336749530
- Entity type
- Organization (NPI-2)
- Legal business name
- Suffolk Dental Care, PC
- Organization subpart
- No
- Enumeration date
- Oct 27, 2020
- Certification date
- Oct 27, 2020
- Last updated
- Oct 27, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
Practice location
3650 Route 112 Ste 105Coram, NY 11727-4131
Phone 631-732-3400 · Fax 631-732-3401
Mailing address
1040 1st Ave # 393New York, NY 10022-2991
Authorized official
Johanny Rodriguez
Director Of Operations
9175835457
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