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General NPI Number Information
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NPI Number | 1104143262
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Entity Type | Organization
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Legal Business Name | WESTCHESTER ELITE DENTAL P.C.
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 460 S BROADWAY FL 2
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City | YONKERS
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State | NY
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Zip | 10705-2340
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Country | US
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Telephone | 914-378-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 460 S BROADWAY FL 2
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City | YONKERS
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State | NY
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Zip | 10705-2340
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Country | US
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Telephone | 914-378-0918
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON VICTOR GEDEON
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Credential | D.M.D.
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Telephone | 914-378-0918
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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 | 054638-1
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License Number State | NY
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