Healthcare Provider Details

I. General information

NPI: 1376997908
Provider Name (Legal Business Name): COSMETIC DENTISTRY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 ROUTE 202 STE 14
POMONA NY
10970-2922
US

IV. Provider business mailing address

1540 ROUTE 202 STE 14
POMONA NY
10970-2922
US

V. Phone/Fax

Practice location:
  • Phone: 845-364-0400
  • Fax: 845-364-5189
Mailing address:
  • Phone: 845-364-0400
  • Fax: 845-364-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number036021-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER R AUSTER
Title or Position: DENTIST
Credential: D.M.D.
Phone: 845-364-0400