Provider Demographics
NPI:1548334766
Name:SAYVILLE FAMILY DENTISTRY
Entity type:Organization
Organization Name:SAYVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CARONIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-589-0672
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-0359
Mailing Address - Country:US
Mailing Address - Phone:631-589-0672
Mailing Address - Fax:631-589-4492
Practice Address - Street 1:207 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2505
Practice Address - Country:US
Practice Address - Phone:631-589-0672
Practice Address - Fax:631-589-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty