Provider Demographics
NPI:1568508182
Name:FAMILY DENTAL OF HICKSVILLE
Entity Type:Organization
Organization Name:FAMILY DENTAL OF HICKSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:EPAKCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-931-8899
Mailing Address - Street 1:400 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801
Mailing Address - Country:US
Mailing Address - Phone:516-931-8899
Mailing Address - Fax:516-931-3666
Practice Address - Street 1:400 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-931-8899
Practice Address - Fax:516-931-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty