Provider Demographics
NPI:1619952835
Name:DAVID - CARRASCO, MARIA CRISTINA CRISTINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA CRISTINA
Middle Name:CRISTINA
Last Name:DAVID - CARRASCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:182 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596
Mailing Address - Country:US
Mailing Address - Phone:516-746-6251
Mailing Address - Fax:516-746-5078
Practice Address - Street 1:182 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596
Practice Address - Country:US
Practice Address - Phone:516-746-6251
Practice Address - Fax:516-746-5078
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04997711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02500049Medicaid