Provider Demographics
NPI:1144812975
Name:NORTH SHORE FAMILY DENTAL CARE PLLC
Entity type:Organization
Organization Name:NORTH SHORE FAMILY DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-625-0088
Mailing Address - Street 1:1044 NORTHERN BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1507
Mailing Address - Country:US
Mailing Address - Phone:516-625-0088
Mailing Address - Fax:516-625-0088
Practice Address - Street 1:1044 NORTHERN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1507
Practice Address - Country:US
Practice Address - Phone:516-625-0088
Practice Address - Fax:516-625-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710483425OtherNPPES
1730327537OtherNPPES
1063909950OtherNPPES
1366916215OtherNPPES