Provider Demographics
NPI:1619566718
Name:KATHLEEN M. FROST, DDS PC
Entity Type:Organization
Organization Name:KATHLEEN M. FROST, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-581-3100
Mailing Address - Street 1:150 ISLIP AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3222
Mailing Address - Country:US
Mailing Address - Phone:631-581-3100
Mailing Address - Fax:631-581-8164
Practice Address - Street 1:150 ISLIP AVE STE 11
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3222
Practice Address - Country:US
Practice Address - Phone:631-581-3100
Practice Address - Fax:631-581-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty