Individual provider · NPI-1

Clarisa Amarillas Gastelum, DDS,MS

Dentist · Stony Brook, NY

NPI number1891214995
StatusActive
Last updated in NPPESSep 11, 2017

Details

NPI
1891214995
Entity type
Individual (NPI-1)
Name
Clarisa Amarillas Gastelum
Credential
DDS,MS
Sex
Female
Sole proprietor
No
Enumeration date
Sep 11, 2017
Last updated
Sep 11, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist000083NYYes

Practice location

Stony Brook School Of Dental Medicine South Drive
Stony Brook, NY 11794-0001

Phone 631-632-8631

Mailing address

127 Westchester Hall
Stony Brook, NY 11794-8705

Phone 631-632-8631

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