MEDICARE: SOUTH NASSAU DENTAL ARTS PC

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	1223G0001X	General Practice Dentistry
2	122300000X	Dentist

General Provider Information

NPI Number	:	1164732392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH NASSAU DENTAL ARTS PC

Provider Business Mailing Address
First Line	:	85 NORTH PARK AVENUE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-4105
Country	:	US
Telephone Number	:	516-763-4500
Fax Number	:	516-763-4502

Provider Business Practice Location Address
First Line	:	85 NORTH PARK AVENUE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-4105
Country	:	US
Telephone Number	:	516-763-4500
Fax Number	:	516-763-4502

Authorized Official
Title or Position	:	OWNER/C.E.O.
Name	:	DR. ADAM SHOUKRY
Credential	:	D.D.S.
Telephone Number	:	516-763-4500

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	02/16/2024

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