Healthcare Provider Details

I. General information

NPI: 1922771674
Provider Name (Legal Business Name): PETER BEDFORD DEMAREST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PONDFIELD RD STE 304
BRONXVILLE NY
10708-3706
US

IV. Provider business mailing address

1 PONDFIELD RD STE 304
BRONXVILLE NY
10708-3706
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-4700
  • Fax: 914-395-1460
Mailing address:
  • Phone: 914-337-4700
  • Fax: 914-395-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number045726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: