=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073711750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARCHMONT ORTHEDONTICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 RAILROAD WAY
-----------------------------------------------------
City | LARCHMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-834-0305
-----------------------------------------------------
Fax | 914-833-9798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 RAILROAD WAY
-----------------------------------------------------
City | LARCHMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-834-0305
-----------------------------------------------------
Fax | 914-833-9798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GARNETT A WESTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 914-834-0305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 050070
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------