Marine Dental Services | |
255 Mason Ave. Staten Island NY 10305-3416 | |
(718) 987-6543 | |
(718) 987-6542 |
Full Name | Marine Dental Services |
---|---|
Speciality | Dentist - General Practice |
Location | 255 Mason Ave., Staten Island, New York |
Authorized Official Name and Position | Jack Miceli (PRESIDENT) |
Authorized Official Contact | 7189876543 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Marine Dental Services 255 Mason Ave. Staten Island NY 10305-3416 Ph: (718) 987-6543 | Marine Dental Services 255 Mason Ave. Staten Island NY 10305-3416 Ph: (718) 987-6543 |
NPI Number | 1932266566 |
---|---|
Provider Enumeration Date | 01/02/2007 |
Last Update Date | 02/23/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932266566 | NPI | - | NPPES |
02353280 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 39067 (New York) | Primary |
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