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General NPI Number Information
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NPI Number | 1679753669
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Entity Type | Organization
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Legal Business Name | NORTH SHORE PERIODONTICS, PC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 2001 MARCUS AVE STE E244 SUITE E244
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1011
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Country | US
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Telephone | 516-706-2912
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 MARCUS AVE STE E244 SUITE E244
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1011
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Country | US
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Telephone | 516-706-2912
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY DAVIS
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Credential | DMD
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Telephone | 516-775-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 043137
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License Number State | NY
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