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General NPI Number Information
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NPI Number | 1427180421
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Entity Type | Organization
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Legal Business Name | WESTCHESTER PUTNAM ENDODONTIC ASSOCIATES
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 101 S BEDFORD RD STE.410
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3439
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Country | US
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Telephone | 914-636-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 77 QUAKER RIDGE RD STE.410
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-2808
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Country | US
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Telephone | 914-636-4343
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICK MASTROMIHALIS
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Credential | DMD
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Telephone | 914-636-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 028744
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License Number State | NY
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