Provider Demographics
NPI:1093857658
Name:DENTAL ASSOCIATES OF VALLEY STREAM PC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF VALLEY STREAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-825-8695
Mailing Address - Street 1:17 WEST MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-825-6695
Mailing Address - Fax:516-825-6642
Practice Address - Street 1:17 WEST MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-825-6695
Practice Address - Fax:516-825-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty