Provider Demographics
NPI:1275793317
Name:GREGORY J HASKIN DDS PC
Entity Type:Organization
Organization Name:GREGORY J HASKIN DDS PC
Other - Org Name:KINGS HIGHWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:HASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-692-4791
Mailing Address - Street 1:4571 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2025
Mailing Address - Country:US
Mailing Address - Phone:718-692-4791
Mailing Address - Fax:718-692-3362
Practice Address - Street 1:4571 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2025
Practice Address - Country:US
Practice Address - Phone:718-692-4791
Practice Address - Fax:718-692-3362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399641122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty