Healthcare Provider Details

I. General information

NPI: 1699274829
Provider Name (Legal Business Name): WESTCHESTER DENTAL DESIGN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 CENTRAL PARK AVE STE 201
YONKERS NY
10710-2949
US

IV. Provider business mailing address

15 CROSSWAY
SCARSDALE NY
10583-7117
US

V. Phone/Fax

Practice location:
  • Phone: 914-961-1700
  • Fax: 914-961-1799
Mailing address:
  • Phone: 914-961-1700
  • Fax: 914-961-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number054821
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number023062
License Number StateNY

VIII. Authorized Official

Name: DR. LOKESH C RAO
Title or Position: OWNER
Credential: DDS
Phone: 914-961-1700