Provider Demographics
NPI:1396744363
Name:HOM, DAVID K (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:HOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-0304
Mailing Address - Country:US
Mailing Address - Phone:516-874-6499
Mailing Address - Fax:
Practice Address - Street 1:240 GLEN HEAD RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1954
Practice Address - Country:US
Practice Address - Phone:516-356-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice