Provider Demographics
NPI:1417076092
Name:MERCURIO, CHRISTINA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:A
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:KOSZALKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:32 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2032
Mailing Address - Country:US
Mailing Address - Phone:516-747-7333
Mailing Address - Fax:
Practice Address - Street 1:3 SCHOOL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2548
Practice Address - Country:US
Practice Address - Phone:516-676-5430
Practice Address - Fax:516-676-5422
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0458851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry