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General NPI Number Information
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NPI Number | 1790921062
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Entity Type | Organization
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Legal Business Name | INTO WHITE DENTAL ARTS, PLLC
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 11/05/2011
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Provider Practice Location Address
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Address Line | 4743 VERNON BLVD GROUND FLOOR
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-5519
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Country | US
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Telephone | 718-361-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 4743 VERNON BLVD GROUND FLOOR
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-5519
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Country | US
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Telephone | 718-361-3050
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST-PROSTHODONTIST
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Name | DR. STEVEN KONSTANTINE MANTINAOS
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Credential | D.D.S.
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Telephone | 718-361-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5067165
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License Number State | NY
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