Provider Demographics
NPI:1437216298
Name:FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:FAMILY AND COSMETIC DENTISTRY
Other - Org Name:DRS. STANISLAUS AND MICHELOTTI
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANISLAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-477-5588
Mailing Address - Street 1:1003 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1501
Mailing Address - Country:US
Mailing Address - Phone:718-477-5588
Mailing Address - Fax:
Practice Address - Street 1:1003 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1501
Practice Address - Country:US
Practice Address - Phone:718-477-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty