Organization
BLACK HALL DENTAL, P.C.
Active
Parent organization
BLACK HALL DENTAL, P.C.
Other names
1999 Marcus Ave DME
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK HALL DENTAL, P.C.
Authorized official
THERESA FAN DDS (ADMINISTRATOR)
(516) 441-5131
Entity
Organization
Contact information
Practice address
1999 MARCUS AVE STE M1, NEW HYDE PARK, NY 11042-1023
(516) 441-5131
Mailing address
1999 MARCUS AVE STE M1, NEW HYDE PARK, NY 11042-1023
(516) 441-5131
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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