Provider Demographics
NPI:1235362336
Name:SCORSESE, SALVATORE (DDS)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:SCORSESE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 61 STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3554
Mailing Address - Country:US
Mailing Address - Phone:718-429-5656
Mailing Address - Fax:718-458-5205
Practice Address - Street 1:3973 61ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3554
Practice Address - Country:US
Practice Address - Phone:171-842-9565
Practice Address - Fax:171-845-8520
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034208-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice