Healthcare Provider Details

I. General information

NPI: 1588049670
Provider Name (Legal Business Name): GENTLE CARE PEDIATRIC DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DAYTON LN SUITE #103
PEEKSKILL NY
10566-2859
US

IV. Provider business mailing address

50 DAYTON LN SUITE #103
PEEKSKILL NY
10566-2859
US

V. Phone/Fax

Practice location:
  • Phone: 914-402-6980
  • Fax:
Mailing address:
  • Phone: 914-402-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number053850
License Number StateNY

VIII. Authorized Official

Name: DR. JAISH JOHN MARKOS
Title or Position: OWNER
Credential: DMD
Phone: 914-402-6980