Healthcare Provider Details

I. General information

NPI: 1295996585
Provider Name (Legal Business Name): NORTHERN WESTCHESTER COUNTY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 STRANG BLVD SUITE 300
YORKTOWN HEIGHTS NY
10598-2939
US

IV. Provider business mailing address

2649 STRANG BLVD SUITE 300
YORKTOWN HEIGHTS NY
10598-2939
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-7977
  • Fax: 914-245-7976
Mailing address:
  • Phone: 914-245-7977
  • Fax: 914-245-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number047222
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH FERTUCCI
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 914-245-7977