MEDICARE: STATEN ISLAND PEDIATRIC DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	0425291	NY

General Provider Information

NPI Number	:	1053509687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN ISLAND PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	195 BRIDGETOWN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6006
Country	:	US
Telephone Number	:	718-761-7316
Fax Number	:	718-761-0558

Provider Business Practice Location Address
First Line	:	195 BRIDGETOWN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6006
Country	:	US
Telephone Number	:	718-761-7316
Fax Number	:	718-761-0558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEBORAH ANNE GRIES
Credential	:	D.M.D.
Telephone Number	:	718-761-7316

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

Similar Medicare Providers

1316935505 — DR. DEBORAH GRIES D.M.D.
Practice Location Address:

195 BRIDGETOWN ST
STATEN ISLAND, NY
10314-6006

Practice Phone: 718-761-7316
Practice Fax: 716-761-0558

1619905346 — MICHELLE ANNE FLANIGAN D.M.D.
Practice Location Address:

195 BRIDGETOWN ST
STATEN ISLAND, NY
10314-6006

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Practice Fax:

1184712853 — DR. SARA JANE SKURNICK DMD
Practice Location Address:

195 BRIDGETOWN STREET , STATEN ISLAND PEDIATRIC DENTAL
STATEN ISLAND, NY
10314-6006

Practice Phone: 718-761-7316
Practice Fax:

1831518331 — YELENA LANGE DDS
Practice Location Address:

195 BRIDGETOWN ST
STATEN ISLAND, NY
10314-6006

Practice Phone: 718-761-7316
Practice Fax:

1689537557 — CARA MARIE RITZ
Practice Location Address:

754 PARKERSVILLE RD
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Practice Fax:

1801535190 — DR. DAVID KARCNIK MD
Practice Location Address:

2655 RICHMOND AVE
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10314-5821

Practice Phone: 718-818-5100
Practice Fax:

Directions to “STATEN ISLAND PEDIATRIC DENTISTRY ” Practice Location

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