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General NPI Number Information
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NPI Number | 1295978245
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Entity Type | Organization
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Legal Business Name | RYE DENTISTRY PLLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 105 THEODORE FREMD AVE
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City | RYE
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State | NY
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Zip | 10580
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Country | US
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Telephone | 914-967-0707
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Fax | 914-967-3411
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Provider Business Mailing Address
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Address Line | 105-107 THEODORE FREMD AVE
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City | RYE
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State | NY
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Zip | 10580
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Country | US
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Telephone | 914-967-0707
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Fax | 914-967-3411
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY LAWRENCE STATMAN
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Credential | DMD
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Telephone | 914-967-0707
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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 | 054238
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License Number State | NY
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