Provider Demographics
NPI:1639228836
Name:BRENTWOOD & BAY SHORE DENTAL ASSOC. LLP
Entity Type:Organization
Organization Name:BRENTWOOD & BAY SHORE DENTAL ASSOC. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-231-9314
Mailing Address - Street 1:652 SUFFOLK AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4391
Mailing Address - Country:US
Mailing Address - Phone:631-231-9314
Mailing Address - Fax:631-952-1243
Practice Address - Street 1:652 SUFFOLK AVE
Practice Address - Street 2:STE 110
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4391
Practice Address - Country:US
Practice Address - Phone:631-231-9314
Practice Address - Fax:631-952-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty