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General NPI Number Information
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NPI Number | 1164732392
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU DENTAL ARTS PC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 85 NORTH PARK AVENUE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4105
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Country | US
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Telephone | 516-763-4500
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Fax | 516-763-4502
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Provider Business Mailing Address
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Address Line | 85 NORTH PARK AVENUE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4105
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Country | US
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Telephone | 516-763-4500
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Fax | 516-763-4502
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Authorized Official
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Title or Position | OWNER/C.E.O.
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Name | DR. ADAM SHOUKRY
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Credential | D.D.S.
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Telephone | 516-763-4500
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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