Provider Demographics
NPI:1053189555
Name:FAMILY DENTAL CARE OF MASSAPEQUA P.C.
Entity type:Organization
Organization Name:FAMILY DENTAL CARE OF MASSAPEQUA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-541-7600
Mailing Address - Street 1:549 BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5012
Mailing Address - Country:US
Mailing Address - Phone:516-541-7600
Mailing Address - Fax:516-541-7607
Practice Address - Street 1:549 BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5012
Practice Address - Country:US
Practice Address - Phone:516-541-7600
Practice Address - Fax:516-541-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental