=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457221244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARMONK PEDIATRIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2025
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 BEDFORD RD STE 4
-----------------------------------------------------
City | ARMONK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10504-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-978-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 BITTERSWEET LN
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-978-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. KEREN ETZION
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 516-978-8728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------