Organization
SMITH HAVEN DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS R DOUGLAS (SOLE MEMBER)
(631) 588-3636
Entity
Organization
Contact information
Practice address
2233 NESCONSET HWY, STE #101, LAKE GROVE, NY 11755-1000
(631) 588-3636
Mailing address
2233 NESCONSET HWY, STE #101, LAKE GROVE, NY 11755-1000
(631) 588-3636
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/12/2015
Last updated
05/12/2015
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