1598038440 NPI number — DAWN-MARIE FELICETTI, DMD P.L.L.C.

Table of content: MRS. SUSAN MARIE KRONK PT (NPI 1891312328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598038440 NPI number — DAWN-MARIE FELICETTI, DMD P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN-MARIE FELICETTI, DMD P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598038440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4224 MERRICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-795-5939
Provider Business Mailing Address Fax Number:
516-795-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4224 MERRICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-795-5939
Provider Business Practice Location Address Fax Number:
516-795-2204
Provider Enumeration Date:
02/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FELICETTI
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
516-795-5939

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  048223 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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