Provider Demographics
NPI:1093737231
Name:PERGOLA, STEVEN GARY (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GARY
Last Name:PERGOLA
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:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11551-1850
Mailing Address - Country:US
Mailing Address - Phone:516-572-8774
Mailing Address - Fax:516-572-6059
Practice Address - Street 1:2201 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1859
Practice Address - Country:US
Practice Address - Phone:516-572-8774
Practice Address - Fax:516-572-6059
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036094122300000X, 1223E0200X, 1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics