Provider Demographics
NPI:1891030599
Name:BRIDGEVIEW DENTAL, PLLC
Entity Type:Organization
Organization Name:BRIDGEVIEW DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-356-9800
Mailing Address - Street 1:4864 ARTHUR KILL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2633
Mailing Address - Country:US
Mailing Address - Phone:718-356-9800
Mailing Address - Fax:718-356-9810
Practice Address - Street 1:4864 ARTHUR KILL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2633
Practice Address - Country:US
Practice Address - Phone:718-356-9800
Practice Address - Fax:718-356-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty