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General NPI Number Information
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NPI Number | 1528284296
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Entity Type | Individual
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Provider Name | MATTHEW EANNACCONE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 177 MAIN ST SUITE 204
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City | HUNTINGTON
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State | NY
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Zip | 11743-6917
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Country | US
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Telephone | 631-427-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 215 OAKWOOD RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-4253
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Country | US
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Telephone | 631-427-8700
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Fax | 631-692-5382
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 041645
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License Number State | NY
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