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General NPI Number Information
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NPI Number | 1134538333
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Entity Type | Organization
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Legal Business Name | BRENTWOOD & BAY SHORE DENTAL ASSOCCIATES LLP
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 27 WICKS RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-4213
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Country | US
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Telephone | 631-231-9314
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Fax | 631-952-1243
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Provider Business Mailing Address
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Address Line | 27 WICKS RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-4213
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Country | US
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Telephone | 631-231-9314
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Fax | 631-952-1243
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELDON GARY MILO
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Credential | DDS
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Telephone | 631-231-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 045455
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 039610
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License Number State | NY
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