Provider Demographics
NPI:1720241706
Name:OCASIO, NATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:OCASIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CLINTON AVE
Mailing Address - Street 2:APT 11H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3572
Mailing Address - Country:US
Mailing Address - Phone:917-701-5080
Mailing Address - Fax:
Practice Address - Street 1:205 CLINTON AVE
Practice Address - Street 2:APT 11H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-777-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist