Healthcare Provider Details

I. General information

NPI: 1043509409
Provider Name (Legal Business Name): SHINE DENTAL ASSOCIATES OF THE NORTH SHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JERICHO TPKE
SYOSSET NY
11791-4509
US

IV. Provider business mailing address

400 JERICHO TPKE
SYOSSET NY
11791-4509
US

V. Phone/Fax

Practice location:
  • Phone: 516-348-8500
  • Fax:
Mailing address:
  • Phone: 516-348-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number043935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC WEINSTEIN
Title or Position: PARTNER
Credential:
Phone: 516-348-8500