Healthcare Provider Details

I. General information

NPI: 1508830324
Provider Name (Legal Business Name): MICHAEL J GULOTTA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PORTION RD STE 15
HOLTSVILLE NY
11742-1074
US

IV. Provider business mailing address

1150 PORTION RD STE 15
HOLTSVILLE NY
11742-1074
US

V. Phone/Fax

Practice location:
  • Phone: 631-696-3820
  • Fax: 631-696-7780
Mailing address:
  • Phone: 631-696-3820
  • Fax: 631-696-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039658
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL J GULOTTA
Title or Position: OWNER
Credential: DDS
Phone: 631-696-3820