Provider Demographics
NPI:1205858545
Name:MITCHNICK, STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:MITCHNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 LONG BEACH RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3240
Mailing Address - Country:US
Mailing Address - Phone:516-766-1516
Mailing Address - Fax:516-255-4693
Practice Address - Street 1:3051 LONG BEACH RD STE 7
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3240
Practice Address - Country:US
Practice Address - Phone:516-766-1516
Practice Address - Fax:516-255-4693
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04408311223E0200X
NJ182001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics