NPI 1003277054

Integrative Dental Care P C

Organisation Customized Equipment (DME) East Islip, NY

Practice location

Address: 127 W Main St, East Islip, NY 11730
Phone: (631) 379-3902
Mailing address: 325 Lake Ave Unit 748, Saint James, NY 11780-5045

Authorised official

Name: Scott Simonetti
Title: President
Phone: (631) 379-3902

Registered specialties

Customized Equipment (DME) Primary

Suppliers Taxonomy 332BC3200X Licence 049510 (NY)

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Registry record

NPI: 1003277054
Entity type: Organization
NPI issued: 17 Mar 2016
Record last updated: 22 Mar 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.