Provider Demographics
NPI:1629159116
Name:EXCELDENT DENTAL OF COMMACK
Entity Type:Organization
Organization Name:EXCELDENT DENTAL OF COMMACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-499-5663
Mailing Address - Street 1:77 VETS MEM HWY
Mailing Address - Street 2:STE 2
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-499-5663
Mailing Address - Fax:631-368-4325
Practice Address - Street 1:77 VETS MEM HWY
Practice Address - Street 2:STE 2
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-499-5663
Practice Address - Fax:631-368-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty