Healthcare Provider Details

I. General information

NPI: 1750657557
Provider Name (Legal Business Name): COMPLETE DENTAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 PARK ST SUITE 201
PEEKSKILL NY
10566-3814
US

IV. Provider business mailing address

1019 PARK ST SUITE 201
PEEKSKILL NY
10566-3814
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-1911
  • Fax: 914-737-1943
Mailing address:
  • Phone: 914-737-1911
  • Fax: 914-737-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number051103
License Number StateNY

VIII. Authorized Official

Name: DR. JOSHUA D ILAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 914-737-1911