Healthcare Provider Details

I. General information

NPI: 1174726376
Provider Name (Legal Business Name): JUDITH ANNE OKUN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RYE RIDGE PLZ SUITE 243
RYE BROOK NY
10573-2826
US

IV. Provider business mailing address

14 RYE RIDGE PLZ SUITE 243
RYE BROOK NY
10573-2826
US

V. Phone/Fax

Practice location:
  • Phone: 914-253-0722
  • Fax: 914-253-0723
Mailing address:
  • Phone: 914-523-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: