Provider Demographics
NPI:1053570796
Name:STANISLAW, KATHY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:STANISLAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S JERSEY AVE UNIT 24
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2036
Mailing Address - Country:US
Mailing Address - Phone:631-941-4988
Mailing Address - Fax:631-941-4830
Practice Address - Street 1:100 S JERSEY AVE UNIT 24
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2036
Practice Address - Country:US
Practice Address - Phone:631-941-4988
Practice Address - Fax:631-941-4830
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0327171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice