Provider Demographics
NPI:1194821454
Name:DOMBROFF & DOS SANTOS DMDS PLLC
Entity Type:Organization
Organization Name:DOMBROFF & DOS SANTOS DMDS PLLC
Other - Org Name:ELLIOTT J DOMBROFF DMD & CELESTINO M DOS SANTOS DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTINO
Authorized Official - Middle Name:MARQUES
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-921-4141
Mailing Address - Street 1:175 JERICHO TURNPIKE
Mailing Address - Street 2:SUITE 307A
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-921-4141
Mailing Address - Fax:316-921-4148
Practice Address - Street 1:175 JERICHO TURNPIKE
Practice Address - Street 2:SUITE 307A
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-921-4141
Practice Address - Fax:316-921-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0296281223G0001X
NY0480521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty