Provider Demographics
NPI:1487742276
Name:CARRASCO, NORIS A (DDS)
Entity type:Individual
Prefix:
First Name:NORIS
Middle Name:A
Last Name:CARRASCO
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 1:30 96 35TH STREET
Mailing Address - Street 2:NORIS A CARRASCO
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103
Mailing Address - Country:US
Mailing Address - Phone:718-204-9566
Mailing Address - Fax:718-204-9568
Practice Address - Street 1:30 96 35TH STREET
Practice Address - Street 2:NORIS A CARRASCO
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103
Practice Address - Country:US
Practice Address - Phone:718-204-9566
Practice Address - Fax:718-204-9568
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00982852Medicaid