Organization
BLACK HALL DENTAL, P.C.
Active
Parent organization
BLACK HALL DENTAL, P.C.
Other names
10 Medical Plaza DME
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK HALL DENTAL, P.C.
Authorized official
THERESA FAN DDS (ADMINISTRATOR)
(516) 674-7646
Entity
Organization
Contact information
Practice address
10 MEDICAL PLZ STE 210, GLEN COVE, NY 11542-2101
(516) 671-2903
Mailing address
10 MEDICAL PLZ STE 210, GLEN COVE, NY 11542-2101
(516) 671-2903
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
04/05/2024
Last updated
04/05/2024
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