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General NPI Number Information
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NPI Number | 1235763418
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Entity Type | Organization
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Legal Business Name | MINT KISCO DENTAL P.C.
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 195 N BEDFORD RD STE 7
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City | MOUNT KISCO
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State | NY
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Zip | 10549-1149
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Country | US
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Telephone | 914-241-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 276 SALEM RD
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City | POUND RIDGE
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State | NY
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Zip | 10576-1320
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Country | US
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Telephone | 914-260-5826
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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. FRANK BOTTINO
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Credential | DMD
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Telephone | 914-260-5826
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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 |
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License Number State |
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