Provider Demographics
NPI:1427153543
Name:CONGIUSTA, DOMINICK MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:MARK
Last Name:CONGIUSTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3310
Mailing Address - Country:US
Mailing Address - Phone:718-836-2228
Mailing Address - Fax:
Practice Address - Street 1:530 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3310
Practice Address - Country:US
Practice Address - Phone:718-836-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03847411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice