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General NPI Number Information
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NPI Number | 1174994529
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Entity Type | Organization
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Legal Business Name | WHITE PLAINS DENTAL PROVIDER PLLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 10 MITCHELL PL STE 102
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4300
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Country | US
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Telephone | 914-683-5203
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Fax | 914-289-0846
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Provider Business Mailing Address
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Address Line | 10 MITCHELL PL STE 102
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4300
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Country | US
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Telephone | 914-683-5203
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Fax | 914-289-0846
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TATIANE GAVIAO
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Credential |
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Telephone | 914-683-5203
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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 | 050677-1
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License Number State | NY
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