Provider Demographics
NPI:1326310913
Name:ARTISTIC DENTAL ASSOCIATES OF COMMACK LLP
Entity Type:Organization
Organization Name:ARTISTIC DENTAL ASSOCIATES OF COMMACK LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROLOGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-499-1212
Mailing Address - Street 1:6080 JERICHO TPKE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2850
Mailing Address - Country:US
Mailing Address - Phone:631-499-1212
Mailing Address - Fax:631-499-2389
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 207
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-499-1212
Practice Address - Fax:631-499-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485341223G0001X
1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty