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General NPI Number Information
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NPI Number | 1710293907
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE AESTHETIC DENTISTRY
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 4891 MERRICK RD
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3804
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Country | US
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Telephone | 516-308-7121
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Fax | 516-308-7122
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Provider Business Mailing Address
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Address Line | 4891 MERRICK RD
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3804
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Country | US
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Telephone | 516-308-7121
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Fax | 516-308-7122
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Authorized Official
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Title or Position | OWNER
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Name | FRANK J TARAANTINO
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Credential | DDS
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Telephone | 516-308-7121
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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 | 052857
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License Number State | NY
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