Healthcare Provider Details

I. General information

NPI: 1346456191
Provider Name (Legal Business Name): MVB DENTAL CARE,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MOUNTAINVIEW DR
THIELLS NY
10984-1410
US

IV. Provider business mailing address

1 MOUNTAINVIEW DR
THIELLS NY
10984-1410
US

V. Phone/Fax

Practice location:
  • Phone: 845-429-8060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number042709-1
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL V BLEYZER
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 845-429-8060