# MODERN DENTISTRY OF LONG ISLAND

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

## Provider details

- **NPI number:** 1487302006
- **Authorized official:** DR. HILSHA CARRION DMD (DENTIST)
- **Authorized official phone:** (631) 473-0582

## Contact information

- **Practice address:** 714 MAIN ST, PORT JEFFERSON, NY 11777-2223
- **Practice address phone:** (631) 473-0582
- **Mailing address:** 5 DOYLE CT, PORT JEFFERSON, NY 11777-1167
- **Mailing address phone:** (631) 560-9536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/13/2022
- **Last updated:** 03/13/2022