Healthcare Provider Details

I. General information

NPI: 1053857532
Provider Name (Legal Business Name): MICHAEL GITLIN DDS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HICKSVILLE RD
BETHPAGE NY
11714-3445
US

IV. Provider business mailing address

99 HICKSVILLE RD
BETHPAGE NY
11714-3445
US

V. Phone/Fax

Practice location:
  • Phone: 516-579-8950
  • Fax: 516-579-0092
Mailing address:
  • Phone: 516-579-8950
  • Fax: 516-579-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057365
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number049803
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057457
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041069
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL GITLIN
Title or Position: OWNER
Credential: DDS
Phone: 516-579-8950