Provider Demographics
NPI:1891312419
Name:CRASTO, GAZELLE JEAN (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:GAZELLE
Middle Name:JEAN
Last Name:CRASTO
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN HEAD RD STE 170
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1935
Mailing Address - Country:US
Mailing Address - Phone:516-484-4741
Mailing Address - Fax:
Practice Address - Street 1:333 GLEN HEAD RD STE 170
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1935
Practice Address - Country:US
Practice Address - Phone:516-484-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064187-011223P0300X
TX36343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist