Provider Demographics
NPI:1851693196
Name:DUGAN HILLS DENTAL PLLC
Entity Type:Organization
Organization Name:DUGAN HILLS DENTAL PLLC
Other - Org Name:DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-668-2900
Mailing Address - Street 1:212 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1308
Mailing Address - Country:US
Mailing Address - Phone:718-668-2900
Mailing Address - Fax:718-928-9444
Practice Address - Street 1:212 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1308
Practice Address - Country:US
Practice Address - Phone:718-668-2900
Practice Address - Fax:718-928-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500442101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty