=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972948404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DA VINCI DENTAL ARTS P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2013
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 MINEOLA AVE
-----------------------------------------------------
City | ROSLYN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11577-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-877-7771
-----------------------------------------------------
Fax | 516-280-4948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 MINEOLA AVE
-----------------------------------------------------
City | ROSLYN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11577-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-877-7771
-----------------------------------------------------
Fax | 516-280-4948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID ISAACS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 516-877-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 051495
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------