Provider Demographics
NPI:1932530466
Name:MK DENTAL L.I. P.C.
Entity Type:Organization
Organization Name:MK DENTAL L.I. P.C.
Other - Org Name:EAST HAMPTON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAMBRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-324-6800
Mailing Address - Street 1:56 THE CIR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2725
Mailing Address - Country:US
Mailing Address - Phone:631-324-6800
Mailing Address - Fax:631-324-7744
Practice Address - Street 1:56 THE CIR
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2725
Practice Address - Country:US
Practice Address - Phone:631-324-6800
Practice Address - Fax:631-324-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0502591223G0001X
NY0511521223G0001X
NY0378031223G0001X
NY0530271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty