Provider Demographics
NPI:1508063264
Name:VERDI, PAUL DOMINIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOMINIC
Last Name:VERDI
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 1:14 VANDERVENTER AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3737
Mailing Address - Country:US
Mailing Address - Phone:516-767-3353
Mailing Address - Fax:516-767-3290
Practice Address - Street 1:14 VANDERVENTER AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3737
Practice Address - Country:US
Practice Address - Phone:516-767-3353
Practice Address - Fax:516-767-3290
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040923-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice