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General NPI Number Information
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NPI Number | 1326310913
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Entity Type | Organization
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Legal Business Name | ARTISTIC DENTAL ASSOCIATES OF COMMACK LLP
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 6080 JERICHO TPKE SUITE 207
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City | COMMACK
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State | NY
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Zip | 11725-2850
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Country | US
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Telephone | 631-499-1212
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Fax | 631-499-2389
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Provider Business Mailing Address
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Address Line | 6080 JERICHO TPKE SUITE 207
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City | COMMACK
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State | NY
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Zip | 11725-2850
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Country | US
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Telephone | 631-499-1212
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Fax | 631-499-2389
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. GEORGE KOROLOGOS
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Credential | DDS
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Telephone | 631-499-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 048534
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License Number State | NY
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