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General NPI Number Information
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NPI Number | 1306390182
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Entity Type | Organization
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Legal Business Name | DELLANIRA ROSARIO-LEGER DENTISTRY
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 701 W 179TH ST APT 3
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City | NEW YORK
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State | NY
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Zip | 10033-6027
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Country | US
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Telephone | 212-740-1208
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Fax | 212-740-7755
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Provider Business Mailing Address
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Address Line | 701 W 179TH ST APT 3
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City | NEW YORK
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State | NY
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Zip | 10033-6027
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Country | US
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Telephone | 212-740-1208
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Fax | 212-740-7755
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Authorized Official
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Title or Position | DIRECTOR OF CORPORATION
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Name | DELLANIRA ROSARIO-LEGER
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Credential | DDS
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Telephone | 212-740-1208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 042475
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License Number State | NY
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