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General NPI Number Information
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NPI Number | 1174124291
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Entity Type | Organization
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Legal Business Name | SWEET TOOTH PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 15 1ST ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2201
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Country | US
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Telephone | 929-833-2424
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Fax | 929-833-2444
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Provider Business Mailing Address
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Address Line | 6795 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3819
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Country | US
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Telephone | 718-967-2412
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Fax | 718-554-4515
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH MICHAEL MEROLA
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Credential | DMD
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Telephone | 929-833-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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