Organization Name: | INTEGRATIVE DENTAL CARE P C |
NPI Number: | 1003277054 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SCOTT SIMONETTI (PRESIDENT) |
Mailing Address: | 127 W Main St East Islip |
State: | NY US |
Postal Code: | 11730 |
Phone Number: | 6313793902 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2016 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 049510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |