Provider Demographics
NPI:1497963912
Name:EXCELDENT DENTAL OF ISLANDIA, LLP
Entity Type:Organization
Organization Name:EXCELDENT DENTAL OF ISLANDIA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-348-7777
Mailing Address - Street 1:1601 VETERANS HWY
Mailing Address - Street 2:STE 200
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749
Mailing Address - Country:US
Mailing Address - Phone:631-348-7777
Mailing Address - Fax:631-348-7794
Practice Address - Street 1:1601 VETERANS HWY
Practice Address - Street 2:STE 200
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-348-7777
Practice Address - Fax:631-348-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty