Organization
ADVANCED DENTAL TECHNOLOGIES COR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C PETERSON D.D.S (PRESIDENT)
(516) 536-5777
Entity
Organization
Contact information
Practice address
2983 LONG BEACH RD, OCEANSIDE, NY 11572-3204
(516) 536-5777
Mailing address
2983 LONG BEACH RD, OCEANSIDE, NY 11572-3204
(516) 536-5777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
029836-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00304132
—
NY
Enumeration date
03/30/2015
Last updated
07/20/2015
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