Provider Demographics
NPI:1720111446
Name:CUTOLO, DOROTHY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:MARIE
Last Name:CUTOLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BROADWAY
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2326
Mailing Address - Country:US
Mailing Address - Phone:516-798-1900
Mailing Address - Fax:516-798-4506
Practice Address - Street 1:708 BROADWAY
Practice Address - Street 2:SUITE ONE
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2326
Practice Address - Country:US
Practice Address - Phone:516-798-1900
Practice Address - Fax:516-798-4506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice