Provider Demographics
NPI:1295123537
Name:STAT DENTAL PC
Entity type:Organization
Organization Name:STAT DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LADER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631516-795-7500
Mailing Address - Street 1:4160 MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-795-7500
Mailing Address - Fax:516-795-8102
Practice Address - Street 1:4160 MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-795-7500
Practice Address - Fax:516-795-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030670-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental