Provider Demographics
NPI:1548792559
Name:SEAPORT DENTAL
Entity Type:Organization
Organization Name:SEAPORT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZUHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-991-8700
Mailing Address - Street 1:492 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5529
Mailing Address - Country:US
Mailing Address - Phone:631-991-8700
Mailing Address - Fax:631-450-4811
Practice Address - Street 1:492 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5529
Practice Address - Country:US
Practice Address - Phone:631-991-8700
Practice Address - Fax:631-450-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042790-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization