Justin Bral, DDS
Individual provider Active NPI Dentist · Roslyn, NY
NPI 1023469871 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1023469871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 059227 (NY)
- Practice address
- 63 Cricket Club Dr
Roslyn, NY 11576-2907 - Phone
- (516) 458-6624
- NPI assigned
- Jun 23, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059227 | NY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 059227 | NY | Yes |
Addresses
Primary practice location
63 Cricket Club Dr
Roslyn, NY 11576-2907
Mailing address
63 Cricket Club Dr
Roslyn, NY 11576-2907
Phone (516) 458-6624
Other providers in Roslyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.