Provider Demographics
NPI:1457457947
Name:EXCELDENT OF OCEANSIDE
Entity Type:Organization
Organization Name:EXCELDENT OF OCEANSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-766-6780
Mailing Address - Street 1:2940 LINCOLN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2195
Mailing Address - Country:US
Mailing Address - Phone:516-766-6780
Mailing Address - Fax:516-678-7794
Practice Address - Street 1:2940 LINCOLN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2195
Practice Address - Country:US
Practice Address - Phone:516-766-6780
Practice Address - Fax:516-678-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty