MEDICARE: TERRACE DENTAL ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		NY

General Provider Information

NPI Number	:	1497772339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRACE DENTAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	859 CONNETQUOT AVE
Second Line	:	SUITE 1
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-3100
Fax Number	:	631-277-3107

Provider Business Practice Location Address
First Line	:	859 CONNETQUOT AVE
Second Line	:	SUITE 1
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-3100
Fax Number	:	631-277-3107

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. NICK VITTORIA
Credential	:	DMD
Telephone Number	:	631-277-3100

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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