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General NPI Number Information
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NPI Number | 1972655512
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Entity Type | Organization
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Legal Business Name | PARK DENTAL LLP
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 1035 PARK BLVD STE 1A
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762
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Country | US
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Telephone | 516-798-9184
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Fax | 516-795-8612
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Provider Business Mailing Address
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Address Line | 1035 PARK BLVD STE 1A
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762
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Country | US
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Telephone | 516-798-9184
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Fax | 516-795-8612
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD CASSARO
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Credential | DDS
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Telephone | 516-798-9184
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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 |
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License Number State |
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