Provider Demographics
NPI:1871186767
Name:EAST SETAUKET DENTAL, P.C.
Entity Type:Organization
Organization Name:EAST SETAUKET DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-689-9719
Mailing Address - Street 1:3250 NESCONSET HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3331
Mailing Address - Country:US
Mailing Address - Phone:631-689-9719
Mailing Address - Fax:631-689-9719
Practice Address - Street 1:3250 NESCONSET HWY STE 1
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3331
Practice Address - Country:US
Practice Address - Phone:631-689-9719
Practice Address - Fax:631-689-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental