Provider Demographics
NPI:1679985824
Name:ALTMARK KIDZ DENTISTRY
Entity Type:Organization
Organization Name:ALTMARK KIDZ DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PILAR
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:631-499-2100
Mailing Address - Street 1:77 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3410
Mailing Address - Country:US
Mailing Address - Phone:631-499-2100
Mailing Address - Fax:631-499-2548
Practice Address - Street 1:77 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3410
Practice Address - Country:US
Practice Address - Phone:631-499-2100
Practice Address - Fax:631-499-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05016621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty