Provider Demographics
NPI:1831918879
Name:BRIAN S. MARGOLIS DDS PC
Entity type:Organization
Organization Name:BRIAN S. MARGOLIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:333 GLEN HEAD RD
Mailing Address - Street 2:SUITE # 170
Mailing Address - City:OLD BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:SUITE # 170
Practice Address - City:OLD BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-484-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty