| Port Jefferson Dental Group P. C. | |
|
602 Main St Port Jefferson NY 11777-2203 | |
| (631) 473-0605 | |
| Not Available |
| Full Name | Port Jefferson Dental Group P. C. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 602 Main St, Port Jefferson, New York |
| Authorized Official Name and Position | John C Rutter (PRESIDENT) |
| Authorized Official Contact | 6314731511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Jefferson Dental Group P. C. 602 Main St Port Jefferson NY 11777-2203 Ph: (631) 473-0605 | Port Jefferson Dental Group P. C. 602 Main St Port Jefferson NY 11777-2203 Ph: (631) 473-0605 |
| NPI Number | 1093960890 |
|---|---|
| Provider Enumeration Date | 11/20/2008 |
| Last Update Date | 11/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093960890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 033761 (New York) | Primary |
| 1223G0001X | Dentist - General Practice | 051054 (New York) | Secondary |
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› Verified 8 days ago
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