Provider Demographics
NPI:1750492674
Name:MARTIN R. BOORIN, DMD, PC
Entity type:Organization
Organization Name:MARTIN R. BOORIN, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-776-0716
Mailing Address - Street 1:P.O. BOX 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-940-3690
Mailing Address - Fax:631-940-7227
Practice Address - Street 1:1087 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6340
Practice Address - Country:US
Practice Address - Phone:516-776-0716
Practice Address - Fax:631-940-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039997122300000X, 1223D0004X
CT70061223D0004X
NJ2201016064001223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty