Basic Information
Provider Information
NPI: 1679944037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONSTANT
FirstName: WILLER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 E 53RD ST APT 5Y
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112342344
CountryCode: US
TelephoneNumber: 3473937909
FaxNumber:  
Practice Location
Address1: 6200 BEACH CHANNEL DR
Address2:  
City: ARVERNE
State: NY
PostalCode: 116921409
CountryCode: US
TelephoneNumber: 7189457150
FaxNumber: 7189452596
Other Information
ProviderEnumerationDate: 10/12/2015
LastUpdateDate: 10/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X058259-1NYY Dental ProvidersDentist 

No ID Information.


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