Provider Demographics
NPI:1609536390
Name:COMMACK PEDIATRIC DENTISTRY, P.C.
Entity type:Organization
Organization Name:COMMACK PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-670-6580
Mailing Address - Street 1:2171 JERICHO TPKE STE 145
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2900
Mailing Address - Country:US
Mailing Address - Phone:631-670-6580
Mailing Address - Fax:
Practice Address - Street 1:2171 JERICHO TPKE STE 145
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2900
Practice Address - Country:US
Practice Address - Phone:631-670-6580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty