Provider Demographics
NPI:1174124291
Name:SWEET TOOTH PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SWEET TOOTH PEDIATRIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEROLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:929-833-2424
Mailing Address - Street 1:6795 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3819
Mailing Address - Country:US
Mailing Address - Phone:718-967-2412
Mailing Address - Fax:718-554-4515
Practice Address - Street 1:15 1ST ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2201
Practice Address - Country:US
Practice Address - Phone:929-833-2424
Practice Address - Fax:929-833-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty