Provider Demographics
NPI:1497562896
Name:TINY TEETH PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:TINY TEETH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-350-4502
Mailing Address - Street 1:59 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1312
Mailing Address - Country:US
Mailing Address - Phone:516-350-4502
Mailing Address - Fax:
Practice Address - Street 1:297 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1502
Practice Address - Country:US
Practice Address - Phone:516-272-4450
Practice Address - Fax:516-272-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty