Provider Demographics
NPI:1710093190
Name:KALMAR FAMILY DENTISTRY LLP
Entity Type:Organization
Organization Name:KALMAR FAMILY DENTISTRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KALMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-673-0670
Mailing Address - Street 1:62 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6912
Mailing Address - Country:US
Mailing Address - Phone:631-673-0670
Mailing Address - Fax:631-673-7091
Practice Address - Street 1:62 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6912
Practice Address - Country:US
Practice Address - Phone:631-673-0670
Practice Address - Fax:631-673-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0062159Medicaid