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General NPI Number Information
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NPI Number | 1619018405
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Entity Type | Organization
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Legal Business Name | BAYSIDE FAMILY DENTAL PRACTICE PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21333 39TH AVE STE 302
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City | BAYSIDE
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State | NY
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Zip | 11361-2071
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Country | US
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Telephone | 718-423-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 21333 39TH AVE STE 302
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City | BAYSIDE
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State | NY
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Zip | 11361-2071
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MARIANA SAPIR
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Credential | D.D.S
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Telephone | 718-423-2626
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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 | 041797
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License Number State | NY
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