Provider Demographics
NPI:1184089062
Name:MERRICK DENTAL CARE
Entity type:Organization
Organization Name:MERRICK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASSOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:KATECHIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-378-1725
Mailing Address - Street 1:1846 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2730
Mailing Address - Country:US
Mailing Address - Phone:516-378-1725
Mailing Address - Fax:516-223-6406
Practice Address - Street 1:1846 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2730
Practice Address - Country:US
Practice Address - Phone:516-378-1725
Practice Address - Fax:516-223-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty