Provider Demographics
NPI:1053884973
Name:THAW, MILDRED ECHEVARRIA (RDH)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:ECHEVARRIA
Last Name:THAW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:MILLIE
Other - Middle Name:E
Other - Last Name:THAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:DR. NICHOLAS TUCCI
Mailing Address - Street 2:800 COMMUNITY DRIVE
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-466-0053
Mailing Address - Fax:
Practice Address - Street 1:162 W 19TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4834
Practice Address - Country:US
Practice Address - Phone:516-314-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012545124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012545OtherDENTAL HYGIENE LICENSE