Healthcare Provider Details

I. General information

NPI: 1669462750
Provider Name (Legal Business Name): CHILMARK DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PLEASANTVILLE RD
OSSINING NY
10562
US

IV. Provider business mailing address

15 PLEASANTVILLE RD
OSSINING NY
10562
US

V. Phone/Fax

Practice location:
  • Phone: 914-941-2200
  • Fax: 914-941-5174
Mailing address:
  • Phone: 914-941-2200
  • Fax: 914-941-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0399661
License Number StateNY

VIII. Authorized Official

Name: DR. ETTA JOYCE LOBEL
Title or Position: DENTIST
Credential: DMD
Phone: 914-941-2200