Individual
DR. EDWARD STEPHEN KONDAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
135 3RD ST, 19-20 STERLINGTON COMMONS, GREENPORT, NY 11944-1640
(631) 477-1177
(631) 477-1175
Mailing address
PO BOX 98, GREENPORT, NY 11944-0098
(631) 477-1177
(631) 477-1175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
035632
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00632866
—
NC
01
—
035632
LICENSE NUMBER
NY
Enumeration date
06/19/2007
Last updated
07/08/2007
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