Provider Demographics
NPI:1336281690
Name:STANISLAUS, EUGENE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:D
Last Name:STANISLAUS
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 1:189 MONTAGUE ST
Mailing Address - Street 2:STE. 800B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-857-6639
Mailing Address - Fax:718-857-8436
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:STE. 800B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-857-6639
Practice Address - Fax:718-857-8436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice