Provider Demographics
NPI:1356568737
Name:KAMPF, PETER R (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:KAMPF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 BROADHOLLOW RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4901
Mailing Address - Country:US
Mailing Address - Phone:631-315-1400
Mailing Address - Fax:516-677-0064
Practice Address - Street 1:150 BROADHOLLOW RD STE 302
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4901
Practice Address - Country:US
Practice Address - Phone:631-315-1400
Practice Address - Fax:516-677-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0441221223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist