Provider Demographics
NPI:1497772339
Name:TERRACE DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:TERRACE DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-277-3100
Mailing Address - Street 1:859 CONNETQUOT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1400
Mailing Address - Country:US
Mailing Address - Phone:631-277-3100
Mailing Address - Fax:631-277-3107
Practice Address - Street 1:859 CONNETQUOT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1400
Practice Address - Country:US
Practice Address - Phone:631-277-3100
Practice Address - Fax:631-277-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty