Provider Demographics
NPI:1447490917
Name:TANNENBAUM, AMY BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:TANNENBAUM
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 1:64 DIVISION AVE
Mailing Address - Street 2:SUITE 215C
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756
Mailing Address - Country:US
Mailing Address - Phone:516-644-2218
Mailing Address - Fax:516-644-2219
Practice Address - Street 1:1644 DEER PARK AVE.
Practice Address - Street 2:PARK HILLS DENTAL CENTER
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:631-586-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist