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General NPI Number Information
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NPI Number | 1225216229
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Entity Type | Organization
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Legal Business Name | EVELYN R. TEJEDA, D.M.D P.C
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 629 W 185TH ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10033-3102
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Country | US
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Telephone | 212-568-0558
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Fax | 212-543-2503
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Provider Business Mailing Address
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Address Line | 70 LOCUST AVE STE B307
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7361
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Country | US
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Telephone | 212-568-0558
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Fax | 212-543-2503
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Authorized Official
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Title or Position | PHYSICIAN
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Name | EVELYN R TEJEDA
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Credential | D.M.D
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Telephone | 914-420-7941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 046830
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License Number State | NY
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