MEDICARE: RIDGECREST DENTAL, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	038619	NY

General Provider Information

NPI Number	:	1548323538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGECREST DENTAL, P.C.

Provider Business Mailing Address
First Line	:	550 LATONA RD
Second Line	:	BLDG. B, SUITE 200
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2700
Country	:	US
Telephone Number	:	585-254-4600
Fax Number	:	585-458-0944

Provider Business Practice Location Address
First Line	:	550 LATONA RD
Second Line	:	BLDG. B, SUITE 200
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2700
Country	:	US
Telephone Number	:	585-254-4600
Fax Number	:	585-458-0944

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	DR. DARREN M. MASCIA
Credential	:	DDS
Telephone Number	:	585-254-4600

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/11/2026

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