Healthcare Provider Details

I. General information

NPI: 1265734693
Provider Name (Legal Business Name): THE CENTER FOR COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 UNDERHILL AVE
WEST HARRISON NY
10604-2539
US

IV. Provider business mailing address

147 UNDERHILL AVE
WEST HARRISON NY
10604-2539
US

V. Phone/Fax

Practice location:
  • Phone: 914-761-8229
  • Fax:
Mailing address:
  • Phone: 914-761-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L. RIOSECO
Title or Position: DENTIST
Credential:
Phone: 914-761-8229