Provider Demographics
NPI:1235574278
Name:RICHMOND HILL DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:RICHMOND HILL DENTAL GROUP, PLLC
Other - Org Name:LEFFERTS 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:646-505-8852
Mailing Address - Street 1:10345 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10345 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2000
Practice Address - Country:US
Practice Address - Phone:646-505-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty