Provider Demographics
NPI:1184235939
Name:WESTERN ISLAND DENTAL CARE PLLC
Entity type:Organization
Organization Name:WESTERN ISLAND DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-302-7372
Mailing Address - Street 1:1900 HEMPSTEAD TPKE STE 402
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1702
Mailing Address - Country:US
Mailing Address - Phone:516-564-8499
Mailing Address - Fax:
Practice Address - Street 1:1900 HEMPSTEAD TPKE STE 402
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1702
Practice Address - Country:US
Practice Address - Phone:516-564-8499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN ISLAND DENTAL CARE (DENTAL SPECIALISTS OF EAST MEADOW)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03269418Medicaid