Basic Information
Provider Information | |||||||||
NPI: | 1639367840 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALES | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11811 GUY R BREWER BLVD | ||||||||
Address2: | JOSEPH P. ADDABO FHC | ||||||||
City: | JAMAICA | ||||||||
State: | NY | ||||||||
PostalCode: | 114342101 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189457150 | ||||||||
FaxNumber: | 7189786888 | ||||||||
Practice Location | |||||||||
Address1: | 118-11 GUY R. BREWER BLVD | ||||||||
Address2: |   | ||||||||
City: | JAMAICA | ||||||||
State: | NY | ||||||||
PostalCode: | 114341952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189457150 | ||||||||
FaxNumber: | 7189786888 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/12/2007 | ||||||||
LastUpdateDate: | 02/20/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 054598 | NY | Y |   | Dental Providers | Dentist | General Practice |
No ID Information.