Provider Demographics
NPI:1689771990
Name:IMPLANT RECONSTRUCTION & GENERAL DENTISTRY OF ROCKLAND, PLLC
Entity Type:Organization
Organization Name:IMPLANT RECONSTRUCTION & GENERAL DENTISTRY OF ROCKLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-357-4100
Mailing Address - Street 1:2 EXECUTIVE BOULEVARD
Mailing Address - Street 2:SUITE #304
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-357-4100
Mailing Address - Fax:845-357-4077
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:SUITE #304
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4164
Practice Address - Country:US
Practice Address - Phone:845-357-4100
Practice Address - Fax:845-357-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0464781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN