Healthcare Provider Details

I. General information

NPI: 1184638637
Provider Name (Legal Business Name): PAUL V. CRESPI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOUNDARY AVE SUITE 302
MASSAPEQUA NY
11758-1152
US

IV. Provider business mailing address

23 PINE HILL DR
DIX HILLS NY
11746-7806
US

V. Phone/Fax

Practice location:
  • Phone: 516-753-5437
  • Fax: 516-753-9027
Mailing address:
  • Phone: 631-385-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number035692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: