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General NPI Number Information
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NPI Number | 1316467269
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Entity Type | Organization
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Legal Business Name | ROSSARIN MITSUMOTO D.D.S., P.C.
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 245 N BROADWAY STE 108
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-2657
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Country | US
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Telephone | 914-332-1272
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Fax | 914-332-1261
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Provider Business Mailing Address
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Address Line | 245 N BROADWAY STE 108
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-2657
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Country | US
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Telephone | 914-332-1272
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Fax | 914-332-1261
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSSARIN MITSUMOTO
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Credential | DDS
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Telephone | 914-332-1272
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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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