Provider Demographics
NPI:1730747486
Name:MARC ADELBERG DDS, PLLC
Entity type:Organization
Organization Name:MARC ADELBERG DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-760-7606
Mailing Address - Street 1:562 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7314
Mailing Address - Country:US
Mailing Address - Phone:631-760-7606
Mailing Address - Fax:
Practice Address - Street 1:562 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7314
Practice Address - Country:US
Practice Address - Phone:631-760-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty