Provider Demographics
NPI:1619247848
Name:ATLANTIC AVENUE DENTAL PC
Entity Type:Organization
Organization Name:ATLANTIC AVENUE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1516-792-6952
Mailing Address - Street 1:96 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3461
Mailing Address - Country:US
Mailing Address - Phone:516-792-6952
Mailing Address - Fax:516-792-6953
Practice Address - Street 1:96 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3461
Practice Address - Country:US
Practice Address - Phone:516-792-6952
Practice Address - Fax:516-792-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50052228-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty