Provider Demographics
NPI:1295830594
Name:COARM-SELDEN DENTAL GROUP
Entity Type:Organization
Organization Name:COARM-SELDEN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-732-9000
Mailing Address - Street 1:280 K MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784
Mailing Address - Country:US
Mailing Address - Phone:631-732-9000
Mailing Address - Fax:631-736-7982
Practice Address - Street 1:280 MIDDLE COUNTRY RD STE K
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2532
Practice Address - Country:US
Practice Address - Phone:631-732-9000
Practice Address - Fax:631-736-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0280781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty