Provider Demographics
NPI:1801038419
Name:FASCILLA, CATHERINE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:FASCILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WESTBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1736
Mailing Address - Country:US
Mailing Address - Phone:516-333-1166
Mailing Address - Fax:516-333-2267
Practice Address - Street 1:505 WESTBURY AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1736
Practice Address - Country:US
Practice Address - Phone:516-333-1166
Practice Address - Fax:516-333-2267
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042360-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist