Healthcare Provider Details

I. General information

NPI: 1912576398
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN AT PEEKSKILL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 05/21/2025
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N. DIVISION ST.
PEEKSKILL NY
10566
US

IV. Provider business mailing address

22 N. DIVISION ST.
PEEKSKILL NY
10566
US

V. Phone/Fax

Practice location:
  • Phone: 914-630-2600
  • Fax: 914-930-1780
Mailing address:
  • Phone: 914-630-2600
  • Fax: 914-930-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE GOMEZ
Title or Position: OWNER
Credential: DMD
Phone: 914-630-2600