Healthcare Provider Details

I. General information

NPI: 1366659112
Provider Name (Legal Business Name): MARY EVE MAESTRE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 CENTRAL PARK W SUITE #1C
NEW YORK NY
10025-7631
US

IV. Provider business mailing address

482 FORT WASHINGTON AVE APT.3#C
NEW YORK NY
10033-4655
US

V. Phone/Fax

Practice location:
  • Phone: 212-280-1700
  • Fax: 212-280-7224
Mailing address:
  • Phone: 212-280-1700
  • Fax: 212-280-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number049029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: