Provider Demographics
NPI:1033471693
Name:OAKWOOD DENTAL ARTS SOUTH SHORE
Entity Type:Organization
Organization Name:OAKWOOD DENTAL ARTS SOUTH SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LARIS
Authorized Official - Last Name:RUGGERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-356-9800
Mailing Address - Street 1:4864 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309
Mailing Address - Country:US
Mailing Address - Phone:718-356-9800
Mailing Address - Fax:
Practice Address - Street 1:4864 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:718-356-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty