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General NPI Number Information
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NPI Number | 1760717292
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Entity Type | Organization
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Legal Business Name | SMITHTOWN ENDODONTICS P.C.
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 285 MIDDLE COUNTRY RD
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City | SMITHTOWN
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State | NY
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Zip | 11787-2978
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Country | US
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Telephone | 516-446-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 285 MIDDLE COUNTRY RD
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City | SMITHTOWN
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State | NY
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Zip | 11787-2978
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Country | US
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Telephone | 516-446-7414
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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. JOSEPH FRANK DIBERNARDO
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Credential | DDS
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Telephone | 516-446-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 051799
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License Number State | NY
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