Healthcare Provider Details

I. General information

NPI: 1568452639
Provider Name (Legal Business Name): DAVID FRANK PASCOE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51100 MAIN RD
SOUTHOLD NY
11971-4655
US

IV. Provider business mailing address

PO BOX 1198
SOUTHOLD NY
11971-0934
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-1919
  • Fax: 631-614-7852
Mailing address:
  • Phone: 631-765-1919
  • Fax: 631-614-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number032590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: