Basic Information
| Provider Information | |||||||||
| NPI: | 1194334607 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASNIS DENTAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 PINELAWN RD STE 150S | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117473187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314147927 | ||||||||
| FaxNumber: | 6313960452 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 ALEXANDER AVE UNIT A | ||||||||
| Address2: | |||||||||
| City: | LAKE GROVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117550429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312656655 | ||||||||
| FaxNumber: | 6313960452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2020 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | SORIANO | ||||||||
| AuthorizedOfficialFirstName: | HIRO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CIO | ||||||||
| AuthorizedOfficialTelephone: | 5163445746 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.