MEDICARE: DR. CATHERINE M. FASCILLA DDS

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	122300000X	Dentist	042360-1	NY

General Provider Information

NPI Number	:	1801038419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE M. FASCILLA DDS

Provider Business Mailing Address
First Line	:	505 WESTBURY AVE
Second Line	:
City	:	CARLE PLACE
State	:	NY
Zip	:	11514-1736
Country	:	US
Telephone Number	:	516-333-1166
Fax Number	:	516-333-2267

Provider Business Practice Location Address
First Line	:	505 WESTBURY AVE
Second Line	:
City	:	CARLE PLACE
State	:	NY
Zip	:	11514-1736
Country	:	US
Telephone Number	:	516-333-1166
Fax Number	:	516-333-2267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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