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Organization
SUITE 2229 DENTAL PLLC
Active
Organization
SUITE 2229 DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA JOHNSON (CRO)
(941) 444-0558
Entity
Organization
Contact information
Practice address
645 COMMACK RD, COMMACK, NY 11725-5401
(631) 858-9800
Mailing address
150 BROADWAY RM 1310, NEW YORK, NY 10038-4365
(212) 587-0202
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
07/21/2026
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