Provider Demographics
NPI:1093295735
Name:GIFFORDS DENTAL, P.C.
Entity Type:Organization
Organization Name:GIFFORDS DENTAL, P.C.
Other - Org Name:GIFFORDS DENTAL, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CISTERNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-414-4993
Mailing Address - Street 1:PO BOX 90081
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-0081
Mailing Address - Country:US
Mailing Address - Phone:917-414-4993
Mailing Address - Fax:
Practice Address - Street 1:79 GIFFORDS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2411
Practice Address - Country:US
Practice Address - Phone:718-984-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528161223G0001X
NY0591571223G0001X
NY0299741223P0300X
NY0490171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty