Provider Demographics
NPI:1528209871
Name:REISFELD, SORIA, GUTTERSON & SHERIDAN DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:REISFELD, SORIA, GUTTERSON & SHERIDAN DENTAL SERVICES, PLLC
Other - Org Name:IANNELLO DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:H
Authorized Official - Last Name:REISFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-724-0104
Mailing Address - Street 1:335 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5510
Mailing Address - Country:US
Mailing Address - Phone:631-724-0104
Mailing Address - Fax:631-724-2861
Practice Address - Street 1:335 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5510
Practice Address - Country:US
Practice Address - Phone:631-724-0104
Practice Address - Fax:631-724-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041693-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty