Provider Demographics
NPI:1740559467
Name:HILLCREST DENTAL CARE PC
Entity Type:Organization
Organization Name:HILLCREST DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-262-1062
Mailing Address - Street 1:1 HILLCREST CENTER DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HILLCREST CENTER DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977
Practice Address - Country:US
Practice Address - Phone:845-262-1062
Practice Address - Fax:845-262-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043154261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental