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General NPI Number Information
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NPI Number | 1366262370
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Entity Type | Individual
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Provider Name | GINA A DOLISI DDS
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Gender | Female
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 525 TOWNLINE RD
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2829
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Country | US
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Telephone | 631-265-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 14 GLEN COVE RD
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-1732
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Country | US
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Telephone | 516-626-2060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 064093
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License Number State | NY
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