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General NPI Number Information
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NPI Number | 1417076092
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Entity Type | Individual
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Provider Name | CHRISTINA A MERCURIO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3 SCHOOL ST SUITE 203
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City | GLEN COVE
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State | NY
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Zip | 11542-2548
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Country | US
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Telephone | 516-676-5430
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Fax | 516-676-5422
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Provider Business Mailing Address
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Address Line | 32 SUMMIT AVE
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City | EAST WILLISTON
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State | NY
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Zip | 11596-2032
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Country | US
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Telephone | 516-747-7333
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 045885
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License Number State | NY
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