Provider Demographics
NPI:1962444216
Name:MARY A. NASSO DDS & ELEANOR J. OLSEN DDS,PC
Entity Type:Organization
Organization Name:MARY A. NASSO DDS & ELEANOR J. OLSEN DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-948-5111
Mailing Address - Street 1:4546 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6400
Mailing Address - Country:US
Mailing Address - Phone:718-948-5111
Mailing Address - Fax:718-948-1932
Practice Address - Street 1:4546 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6400
Practice Address - Country:US
Practice Address - Phone:718-948-5111
Practice Address - Fax:718-948-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty