2791 Richmond LLC
NPI #1003391186 in Staten Island, New York
Provider Information
- NPI Number
- 1003391186
- Entity Type
- Organization
- Organization Name
- 2791 Richmond LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Sep 25, 2018
- Last Updated
- Sep 25, 2018
Practice Location
- Address
- 2791 RICHMOND AVENUE, SUITE 2
- City
- Staten Island
- State
- New York
- ZIP Code
- 10314
- Phone
- (718) 400-9002
Authorized Official
- Name
- TONI LYNN EGAN
- Title
- CREDENTIALING DEPARTMENT
- Phone
- (718) 979-2121
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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