Provider Demographics
NPI:1417594706
Name:SOUTH BAY ORTHODONTICS
Entity Type:Organization
Organization Name:SOUTH BAY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-581-1150
Mailing Address - Street 1:439 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3538
Mailing Address - Country:US
Mailing Address - Phone:516-581-1150
Mailing Address - Fax:631-581-1152
Practice Address - Street 1:439 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3538
Practice Address - Country:US
Practice Address - Phone:516-581-1150
Practice Address - Fax:631-581-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty