Notice of Privacy Practices

Modern Dentistry of Long Island
714 Main Street
Port Jefferson, New York
Phone: 631-473-0582
Effective Date: 2/17/2026
Your Health Information and Your Rights
This notice describes how medical and dental information about you may be used and disclosed, and how you can access this information. Please review it carefully.
You have the right to:
Get a copy of your records
You may request an electronic or paper copy of your dental or medical records. We will provide this within the time required by law and may charge a reasonable, cost-based fee.
Request corrections
You may ask us to correct information you believe is incorrect or incomplete. We may deny certain requests but will provide a written explanation.
Request confidential communications
You may ask us to contact you in a specific way or send mail to a different address. We will accommodate reasonable requests.
Request limits on use or sharing
You may ask us not to use or share certain health information. We are not always required to agree, but we will consider all requests carefully.
If you pay in full out-of-pocket for a service, you may request that we not share information about that service with your insurance company when legally permitted.
Receive an accounting of disclosures
You may request a list of certain disclosures we have made of your health information.
Receive a copy of this notice
You may request a paper copy at any time.
Choose someone to act for you
If you have given someone legal authority, that person may exercise your rights and make choices about your information.
File a complaint
If you believe your privacy rights have been violated, you may contact our office at 631-473-0582.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

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Your Choices
You may tell us your preferences regarding sharing information with:
  • Family members or others involved in your care
  • Individuals responsible for payment
  • Appointment reminders and treatment communications
We will not share your information for marketing or the sale of your information without your written permission.
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How We Use and Share Health Information
We typically use or share your information to:
Provide treatment
We may share information with other dental or medical professionals involved in your care.
Operate our practice
We use information to manage treatment, maintain records, and improve services.
Bill for services
We share information with insurance companies or other payers to obtain payment.
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Other Uses and Disclosures Allowed by Law
We may share health information when required or permitted by law, including:
  • Public health and safety activities
  • Reporting abuse, neglect, or domestic violence
  • Health oversight or regulatory activities
  • Workers’ compensation claims
  • Law enforcement or court orders
  • Preventing serious threats to health or safety

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Our Responsibilities
Modern Dentistry of Long Island is required by law to:
  • Maintain the privacy and security of your protected health information
  • Notify you if a breach occurs
  • Follow the terms of this notice
  • Provide you with a copy upon request
We may update this notice from time to time. The current version will always be available in our office and on our website.
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Contact Information
If you have questions about this notice or your privacy rights, please contact:
Modern Dentistry of Long Island
714 Main Street
Port Jefferson, NY
Phone: 631-473-0582