Provider Demographics
NPI:1043525926
Name:WOODHAVEN ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:WOODHAVEN ORTHODONTICS, PLLC
Other - Org Name:WOODHAVEN BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-850-5555
Mailing Address - Street 1:8708 WOODHAVEN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2159
Mailing Address - Country:US
Mailing Address - Phone:718-850-5555
Mailing Address - Fax:
Practice Address - Street 1:8708 WOODHAVEN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2159
Practice Address - Country:US
Practice Address - Phone:718-850-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty