Provider Demographics
NPI:1548504657
Name:MAMBRINO, DAVID ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:MAMBRINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PANTIGO PL STE 114
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5927
Mailing Address - Country:US
Mailing Address - Phone:631-324-6800
Mailing Address - Fax:631-324-7744
Practice Address - Street 1:300 PANTIGO PL STE 114
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5927
Practice Address - Country:US
Practice Address - Phone:631-324-6800
Practice Address - Fax:631-324-7744
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist