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General NPI Number Information
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NPI Number | 1013937143
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Entity Type | Organization
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Legal Business Name | PRASAD CHILDREN'S DENTAL HEATH PROGRAM, INC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 465 BRICKMAN RD
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City | HURLEYVILLE
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State | NY
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Zip | 12747-6002
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Country | US
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Telephone | 845-434-0376
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Fax | 845-434-1791
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Provider Business Mailing Address
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Address Line | 465 BRICKMAN RD
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City | HURLEYVILLE
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State | NY
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Zip | 12747-5314
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Country | US
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Telephone | 845-434-0376
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Fax | 845-434-1791
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | DR. MARIA CECILIA ESCARRA
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Credential |
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Telephone | 845-434-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5254200R
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License Number State | NY
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