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General NPI Number Information
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NPI Number | 1023479359
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL ANESTHESIA SERVICES
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 111 ROUTE 303 SUITE 220
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City | TAPPAN
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State | NY
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Zip | 10983-2133
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Country | US
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Telephone | 845-848-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 48 BI STATE PLZ # 268
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City | OLD TAPPAN
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State | NJ
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Zip | 07675-7003
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Country | US
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Telephone | 201-660-7464
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROSALIE MENDIA
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Credential |
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Telephone | 201-660-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | D102532800
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License Number State | NJ
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