Provider Demographics
NPI:1851579841
Name:ADELBERG PEDIATRIC DENTAL PC
Entity Type:Organization
Organization Name:ADELBERG PEDIATRIC DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:631-360-7337
Mailing Address - Street 1:260 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:631-360-7337
Mailing Address - Fax:631-360-3815
Practice Address - Street 1:260 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2982
Practice Address - Country:US
Practice Address - Phone:631-360-7337
Practice Address - Fax:631-360-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty