Provider Demographics
NPI:1669863072
Name:GREAT NECK ORTHODONTICS PLLC
Entity type:Organization
Organization Name:GREAT NECK ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PALAGANAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-807-8013
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5338
Mailing Address - Country:US
Mailing Address - Phone:516-466-0146
Mailing Address - Fax:516-466-0760
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5338
Practice Address - Country:US
Practice Address - Phone:516-466-0146
Practice Address - Fax:516-466-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty