Eugene Louis Antenucci, DDS
Individual provider Active NPI General Practice Dentistry · Bay Shore, NY
NPI 1205906807 · NPPES record last updated Feb 8, 2017
Key facts
- NPI
- 1205906807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 38340-1 (NY)
- Practice address
- 1579 Brentwood Rd
Bay Shore, NY 11706-3225 - Phone
- (631) 665-8484
- Fax
- (631) 665-8484
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38340-1 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Madison Dental Management Associates LLC | Past |
Accepting new patients | |
| Robert Ecker DDS David J Engelson DDS PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 38340-1 | NY | Yes |
Addresses
Primary practice location
1579 Brentwood Rd
Bay Shore, NY 11706-3225
Mailing address
1579 Brentwood Rd
Bay Shore, NY 11706-3225
Phone (631) 665-8484
Other providers in Bay Shore, NY
- Alexander Andreev
- Christele Sophia Anemy-Pierre Louis
- Lizanna Angeli
- Linda Liu Angelino
- Samuel Onyemuwa Ani
- Anthony Joseph Rizzo DO PC
- Vida Antwi
- Jessica Aquino
- Ar Testing Corp
- Elaine May Arcenas
All providers in Bay Shore, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.