Provider Demographics
NPI:1093982274
Name:HAMPTON FAMILY DENTAL PC
Entity Type:Organization
Organization Name:HAMPTON FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-653-5888
Mailing Address - Street 1:421 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-3917
Mailing Address - Country:US
Mailing Address - Phone:631-653-5888
Mailing Address - Fax:631-653-7813
Practice Address - Street 1:421 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-3917
Practice Address - Country:US
Practice Address - Phone:631-653-5888
Practice Address - Fax:631-653-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041854021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty