Provider Demographics
NPI:1437293560
Name:STONY BROOK DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:STONY BROOK DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:REINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-444-2925
Mailing Address - Street 1:STATE UNIVERSITY AT STONY BRK
Mailing Address - Street 2:SCHOOL OF DENTAL MEDICINE 170 SULLIVAN HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-632-8971
Mailing Address - Fax:
Practice Address - Street 1:STATE UNIVERSITY AT STONY BRK
Practice Address - Street 2:SCHOOL OF DENTAL MEDICINE 170 SULLIVAN HALL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-632-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty