Provider Demographics
NPI:1225468432
Name:TOTAL DENTAL CARE OF STATEN ISLAND, P.C.
Entity Type:Organization
Organization Name:TOTAL DENTAL CARE OF STATEN ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:ZATCOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-448-1144
Mailing Address - Street 1:135 WILLOWBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302
Mailing Address - Country:US
Mailing Address - Phone:718-448-1144
Mailing Address - Fax:718-815-9028
Practice Address - Street 1:135 WILLOWBROOK ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-448-1144
Practice Address - Fax:718-815-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500555361223G0001X
NY0510101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty