Provider Demographics
NPI:1164519302
Name:UNIVERSAL DENTAL SERVICES OF OCEANSIDE,PC
Entity Type:Organization
Organization Name:UNIVERSAL DENTAL SERVICES OF OCEANSIDE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-536-5340
Mailing Address - Street 1:2812 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2229
Mailing Address - Country:US
Mailing Address - Phone:516-536-5340
Mailing Address - Fax:516-536-5383
Practice Address - Street 1:2812 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2229
Practice Address - Country:US
Practice Address - Phone:516-536-5340
Practice Address - Fax:516-536-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0363751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00752621Medicaid