Provider Demographics
NPI:1801301833
Name:HILLS PARK DENTAL
Entity type:Organization
Organization Name:HILLS PARK DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TADDONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-254-6596
Mailing Address - Street 1:2053 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2110
Mailing Address - Country:US
Mailing Address - Phone:631-254-6596
Mailing Address - Fax:
Practice Address - Street 1:2053 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2110
Practice Address - Country:US
Practice Address - Phone:631-254-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICIA BREEN DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-13
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty