Provider Demographics
NPI:1114935277
Name:TOWN & COUNTRY DENTAL PLLC
Entity Type:Organization
Organization Name:TOWN & COUNTRY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WELEDNIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-423-5216
Mailing Address - Street 1:931 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2231
Mailing Address - Country:US
Mailing Address - Phone:631-423-5216
Mailing Address - Fax:631-423-8001
Practice Address - Street 1:931 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2231
Practice Address - Country:US
Practice Address - Phone:631-423-5216
Practice Address - Fax:631-423-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty