Healthcare Provider Details

I. General information

NPI: 1497874416
Provider Name (Legal Business Name): STEPHEN J. VUOLO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FRANKLIN AVE SUITE L-12
GARDEN CITY NY
11530-5801
US

IV. Provider business mailing address

8 DRIFTWOOD LN
DIX HILLS NY
11746-7940
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-0050
  • Fax: 516-280-5218
Mailing address:
  • Phone: 631-462-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number040074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: