Provider Demographics
NPI:1477333805
Name:523 TOWNLINE DENTAL PLLC
Entity Type:Organization
Organization Name:523 TOWNLINE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-979-7446
Mailing Address - Street 1:523 TOWNLINE ROAD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-979-7446
Mailing Address - Fax:631-979-6781
Practice Address - Street 1:523 TOWNLINE ROAD
Practice Address - Street 2:SUITE 13
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-979-7446
Practice Address - Fax:631-979-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty