Healthcare Provider Details

I. General information

NPI: 1346710241
Provider Name (Legal Business Name): BEDFORD HILLS DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DEPOT PLZ
BEDFORD HILLS NY
10507-1807
US

IV. Provider business mailing address

3 DEPOT PLZ
BEDFORD HILLS NY
10507-1807
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-6845
  • Fax:
Mailing address:
  • Phone: 914-666-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANNA JOVANOVICH
Title or Position: PERIODONTIST
Credential:
Phone: 914-666-6845