Provider Demographics
NPI:1407151715
Name:HAMPTON BAYS DENTAL ASSOC. P.C.
Entity Type:Organization
Organization Name:HAMPTON BAYS DENTAL ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-728-8400
Mailing Address - Street 1:182 W MONTAUK HWY
Mailing Address - Street 2:BLDG. B STE. E
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2345
Mailing Address - Country:US
Mailing Address - Phone:631-728-8400
Mailing Address - Fax:631-728-8482
Practice Address - Street 1:182 W MONTAUK HWY
Practice Address - Street 2:BLDG. B STE. E
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2345
Practice Address - Country:US
Practice Address - Phone:631-728-8400
Practice Address - Fax:631-728-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6480210001Medicare NSC