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General NPI Number Information
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NPI Number | 1255052569
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Entity Type | Organization
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Legal Business Name | TONGUE-TIE DENTAL OF NY PLLC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 774 WHITE PLAINS RD # 205
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City | SCARSDALE
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State | NY
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Zip | 10583-5030
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Country | US
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Telephone | 204-724-7744
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Fax | 203-286-1203
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Provider Business Mailing Address
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Address Line | 7 DARCY LN
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City | EASTCHESTER
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State | NY
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Zip | 10709-1409
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Country | US
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Telephone | 917-841-7780
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Fax | 203-286-1203
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Authorized Official
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Title or Position | MEMBER
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Name | JESSICA LEVY
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Credential | DDS
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Telephone | 917-841-7780
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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 |
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License Number State |
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