Provider Demographics
NPI:1598914236
Name:COMMACK PEDIATRIC DENTAL ASSOC LLP
Entity Type:Organization
Organization Name:COMMACK PEDIATRIC DENTAL ASSOC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-499-2112
Mailing Address - Street 1:164 COMMACK RD.
Mailing Address - Street 2:STE 4
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-499-2112
Mailing Address - Fax:631-858-0586
Practice Address - Street 1:164 COMMACK RD.
Practice Address - Street 2:STE 4
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-499-2112
Practice Address - Fax:631-858-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0352811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty