| Black Hall Dental, P.c. | |
|
1999 Marcus Ave Ste M1 New Hyde Park NY 11042-1023 | |
| (516) 441-5131 | |
| Not Available |
| Full Name | Black Hall Dental, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1999 Marcus Ave Ste M1, New Hyde Park, New York |
| Authorized Official Name and Position | Theresa Fan (ADMINISTRATOR) |
| Authorized Official Contact | 5164415131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Hall Dental, P.c. 1999 Marcus Ave Ste M1 New Hyde Park NY 11042-1023 Ph: (516) 441-5131 | Black Hall Dental, P.c. 1999 Marcus Ave Ste M1 New Hyde Park NY 11042-1023 Ph: (516) 441-5131 |
| NPI Number | 1336991876 |
|---|---|
| Provider Enumeration Date | 04/05/2024 |
| Last Update Date | 04/05/2024 |
| Medicare PECOS PAC ID | 6901283308 |
|---|---|
| Medicare Enrollment ID | O20250404000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336991876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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