Healthcare Provider Details

I. General information

NPI: 1114183365
Provider Name (Legal Business Name): STEVEN W CARNEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 GRAND CONCOURSE
BRONX NY
10457-5221
US

IV. Provider business mailing address

1940 GRAND CONCOURSE
BRONX NY
10457-5221
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-6347
  • Fax: 718-583-8047
Mailing address:
  • Phone: 718-583-6347
  • Fax: 718-583-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE00011168
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number051871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: