Provider Demographics
NPI:1285776492
Name:MAIELLO-PENSIERO, EDA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:EDA
Middle Name:MARIE
Last Name:MAIELLO-PENSIERO
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 1:334 BURR RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1935
Mailing Address - Country:US
Mailing Address - Phone:631-499-3039
Mailing Address - Fax:631-462-7795
Practice Address - Street 1:334 BURR RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1935
Practice Address - Country:US
Practice Address - Phone:631-499-3039
Practice Address - Fax:631-462-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice