Provider Demographics
NPI:1457446965
Name:STONYBROOK DENTAL ASSOC. INC
Entity Type:Organization
Organization Name:STONYBROOK DENTAL ASSOC. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-946-7171
Mailing Address - Street 1:35 STONYBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055
Mailing Address - Country:US
Mailing Address - Phone:215-946-7171
Mailing Address - Fax:215-785-5638
Practice Address - Street 1:35 STONYBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055
Practice Address - Country:US
Practice Address - Phone:215-946-7171
Practice Address - Fax:215-785-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA972541OtherUNITED CONCORDIA PROVIDER
PA=========OtherTAX ID NUMBER