Clove Lakes Family Dental PLLC
Clinic/Center, Dental in Staten Island, NY. Organization (NPI-2).
NPI number1639619208
StatusActive
Last updated in NPPESMar 2, 2017
Details
- NPI
- 1639619208
- Entity type
- Organization (NPI-2)
- Legal business name
- Clove Lakes Family Dental PLLC
- Organization subpart
- No
- Enumeration date
- Mar 2, 2017
- Last updated
- Mar 2, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Oakwood Dental Arts Of Clove Lakes (Doing Business As)
Practice location
1140 Victory BlvdSuite 1
Staten Island, NY 10301-3673
Phone 718-255-8995
Mailing address
1140 Victory BlvdSuite 1
Staten Island, NY 10301-3673
Phone 718-255-8995
Authorized official
Emanuel Graziano
Partner
7188734889
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