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General NPI Number Information
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NPI Number | 1467583716
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Entity Type | Organization
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Legal Business Name | RYE BROOK DENTAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3010 WESTCHESTER AVE SUITE#202
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City | PURCHASE
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State | NY
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Zip | 10577-2535
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Country | US
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Telephone | 914-251-0117
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Fax | 914-251-0254
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Provider Business Mailing Address
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Address Line | 3010 WESTCHESTER AVE SUITE#202
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City | PURCHASE
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State | NY
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Zip | 10577-2535
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Country | US
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Telephone | 914-251-0117
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Fax | 914-251-0254
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Authorized Official
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Title or Position | OWNER
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Name | DR. HENRY R RUSSO
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Credential | D.D.S.
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Telephone | 914-251-0117
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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 | 021113
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 042549-1
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License Number State | NY
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