Provider Demographics
NPI:1477064178
Name:PEDIATRIC DENTISTRY OF NASSAU COUNTY PLLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF NASSAU COUNTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IOANNOU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-568-4569
Mailing Address - Street 1:35 SPRINGWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN CITY PLZ STE 214
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3330
Practice Address - Country:US
Practice Address - Phone:516-280-6734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty