Individual
KRISTEN BROCAVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
150 ISLIP AVE STE 11, ISLIP, NY 11751-3222
(631) 581-3100
Mailing address
3 FARNUM ST, LYNBROOK, NY 11563-3920
(516) 993-8731
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
061138
NY
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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