Provider Demographics
NPI:1598893216
Name:VIZCAYA, CAROLINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:VIZCAYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CEDAR SWAMP RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3700
Mailing Address - Country:US
Mailing Address - Phone:516-987-2449
Mailing Address - Fax:516-671-7960
Practice Address - Street 1:10 CEDAR SWAMP RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3700
Practice Address - Country:US
Practice Address - Phone:516-987-2449
Practice Address - Fax:516-671-7960
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry