Provider Demographics
NPI:1902933609
Name:FAMILY PRACTICE DENTISTRY
Entity Type:Organization
Organization Name:FAMILY PRACTICE DENTISTRY
Other - Org Name:FAMILY PRACTICE DENTISTRY & LASER DENTAL CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-892-7114
Mailing Address - Street 1:1725 EDISON AVE
Mailing Address - Street 2:LOBBY C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4850
Mailing Address - Country:US
Mailing Address - Phone:718-892-7114
Mailing Address - Fax:718-892-7494
Practice Address - Street 1:1725 EDISON AVE
Practice Address - Street 2:LOBBY C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4850
Practice Address - Country:US
Practice Address - Phone:718-892-7114
Practice Address - Fax:718-892-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty