Provider Demographics
NPI:1972522118
Name:STEVEN MITCHNICK, DMD PC
Entity Type:Organization
Organization Name:STEVEN MITCHNICK, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-766-1516
Mailing Address - Street 1:3051 LONG BEACH RD STE 7
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3240
Mailing Address - Country:US
Mailing Address - Phone:516-766-1516
Mailing Address - Fax:516-255-4693
Practice Address - Street 1:3051 LONG BEACH RD STE 7
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3240
Practice Address - Country:US
Practice Address - Phone:516-766-1516
Practice Address - Fax:516-255-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04408311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty