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General NPI Number Information
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NPI Number | 1053716670
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Entity Type | Organization
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Legal Business Name | BREWSTER FAMILY AND COSMETIC DENTAL PC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 504 N MAIN ST
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City | BREWSTER
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State | NY
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Zip | 10509-1230
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Country | US
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Telephone | 845-279-3482
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Fax | 845-278-1782
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Provider Business Mailing Address
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Address Line | 504 N MAIN ST
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City | BREWSTER
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State | NY
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Zip | 10509-1230
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Country | US
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Telephone | 845-279-3482
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Fax | 845-278-1782
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACIE TERRI CALIAN
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Credential | DDS
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Telephone | 845-279-3482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 041695-2
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License Number State | NY
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