Provider Demographics
NPI:1194049015
Name:CANARICK, STEVEN SCOTT (DMD,FAGD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SCOTT
Last Name:CANARICK
Suffix:
Gender:M
Credentials:DMD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GRAND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4908
Mailing Address - Country:US
Mailing Address - Phone:516-798-6503
Mailing Address - Fax:516-798-6509
Practice Address - Street 1:99 GRAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4908
Practice Address - Country:US
Practice Address - Phone:516-798-6503
Practice Address - Fax:516-798-6509
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033857-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist