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General NPI Number Information
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NPI Number | 1417819616
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Entity Type | Organization
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Legal Business Name | NEW YORK DENTISTRY SERVICES PLLC
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 200 BOUNDARY AVE STE 202
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City | MASSAPEQUA
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State | NY
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Zip | 11758-1152
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Country | US
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Telephone | 516-798-6786
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 54TH AVE N STE 205
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City | NASHVILLE
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State | TN
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Zip | 37209-1442
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Country | US
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Telephone | 615-678-0759
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR OF CREDENTIALING
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Name | CHARLOTTE V DASCH
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Credential |
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Telephone | 504-638-0303
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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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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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