Provider Demographics
NPI:1730109786
Name:VERVENIOTIS, STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:VERVENIOTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAPLE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-766-0580
Mailing Address - Fax:516-766-6755
Practice Address - Street 1:24 MAPLE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-766-0580
Practice Address - Fax:516-766-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0422481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U58332Medicare UPIN
NYD15061Medicare ID - Type Unspecified