Provider Demographics
NPI:1629199468
Name:ESSENTIAL DENTAL PC
Entity Type:Organization
Organization Name:ESSENTIAL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-766-2176
Mailing Address - Street 1:36 LINCOLN AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5768
Mailing Address - Country:US
Mailing Address - Phone:516-766-2176
Mailing Address - Fax:516-766-8063
Practice Address - Street 1:36 LINCOLN AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROCKVILLE CENTER
Practice Address - State:NY
Practice Address - Zip Code:11570-5768
Practice Address - Country:US
Practice Address - Phone:516-766-2176
Practice Address - Fax:516-766-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty