Provider Demographics
NPI:1245612514
Name:GOOD NEIGHBOR DENTAL AT GREAT NECK
Entity Type:Organization
Organization Name:GOOD NEIGHBOR DENTAL AT GREAT NECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIOS
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-784-8070
Mailing Address - Street 1:2865 LYNNHAVEN DR
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1542
Mailing Address - Country:US
Mailing Address - Phone:757-481-3000
Mailing Address - Fax:
Practice Address - Street 1:2865 LYNNHAVEN DR
Practice Address - Street 2:SUITE C-4
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1542
Practice Address - Country:US
Practice Address - Phone:757-481-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty