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General NPI Number Information
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NPI Number | 1447490917
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Entity Type | Individual
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Provider Name | AMY BETH TANNENBAUM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 1644 DEER PARK AVE. PARK HILLS DENTAL CENTER
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City | DEER PARK
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State | NY
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Zip | 11729
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Country | US
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Telephone | 631-586-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 64 DIVISION AVE SUITE 215C
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City | LEVITTOWN
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State | NY
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Zip | 11756
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Country | US
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Telephone | 516-644-2218
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Fax | 516-644-2219
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 051766
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License Number State | NY
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