Provider Demographics
NPI:1679188130
Name:GLEN COVE DENTAL P.C.
Entity Type:Organization
Organization Name:GLEN COVE DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-341-0829
Mailing Address - Street 1:44 ELM ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3403
Mailing Address - Country:US
Mailing Address - Phone:631-271-8199
Mailing Address - Fax:
Practice Address - Street 1:44 ELM ST STE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3403
Practice Address - Country:US
Practice Address - Phone:631-271-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty