Provider First Line Business Practice Location Address:
143 WESTCHESTER HALL DEPT OF GENERAL DENTISTRY
Provider Second Line Business Practice Location Address:
SCHOOL OF DENTAL MEDICINE SUNYSB
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-8740
Provider Business Practice Location Address Fax Number:
631-632-3001
Provider Enumeration Date:
02/21/2007