# BLACK HALL DENTAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356091516
- **Authorized official:** MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
- **Authorized official phone:** (516) 321-6058

## Contact information

- **Practice address:** 400 COMMUNITY DR, MANHASSET, NY 11030-3815
- **Practice address phone:** (516) 562-4525
- **Practice address fax:** (516) 562-2470
- **Mailing address:** 400 COMMUNITY DR, MANHASSET, NY 11030-3815
- **Mailing address phone:** (516) 562-4525
- **Mailing address fax:** (516) 562-2470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2022
- **Last updated:** 03/28/2022