Organization
THREE VILLAGE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW EVERETT DDS (PRESIDENT)
(631) 689-3131
Entity
Organization
Contact information
Practice address
2500 NESCONSET HWY, BUILDING 6-B, STONY BROOK, NY 11790-2555
(631) 689-3131
(631) 689-3529
Mailing address
2500 NESCONSET HWY, BUILDING 6-B, STONY BROOK, NY 11790-2555
(631) 689-3131
(631) 689-3529
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
054294
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000000000000000
—
NY
Enumeration date
04/12/2016
Last updated
04/12/2016
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