Healthcare Provider Details

I. General information

NPI: 1417167883
Provider Name (Legal Business Name): DENTAL SPA & BEYOND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 RICHMOND AVE
STATEN ISLAND NY
10312-3827
US

IV. Provider business mailing address

3777 RICHMOND AVE
STATEN ISLAND NY
10312
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-3777
  • Fax: 718-948-0147
Mailing address:
  • Phone: 718-948-3777
  • Fax: 718-948-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number050415
License Number StateNY

VIII. Authorized Official

Name: DR. ANNE GERSHKOWITZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-948-3777