Healthcare Provider Details

I. General information

NPI: 1144812975
Provider Name (Legal Business Name): NORTH SHORE FAMILY DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 NORTHERN BLVD STE 106
ROSLYN NY
11576-1507
US

IV. Provider business mailing address

1044 NORTHERN BLVD STE 106
ROSLYN NY
11576-1507
US

V. Phone/Fax

Practice location:
  • Phone: 516-625-0088
  • Fax: 516-625-0008
Mailing address:
  • Phone: 516-625-0088
  • Fax: 516-625-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KATIE FIGUEROA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 516-625-0088