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General NPI Number Information
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NPI Number | 1477804474
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Entity Type | Organization
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Legal Business Name | NEW ROCHELLE DENTAL STUDIO PC.
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 199 NORTH AVE SUITE #2
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City | NEW ROCHELLE
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State | NY
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Zip | 10801
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Country | US
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Telephone | 914-633-5601
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Fax | 914-633-5222
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Provider Business Mailing Address
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Address Line | 199 NORTH AVE SUITE #2
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City | NEW ROCHELLE
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State | NY
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Zip | 10801
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Country | US
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Telephone | 914-633-5601
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Fax | 914-633-5222
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Authorized Official
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Title or Position | D.D.S
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Name | DR. RUBEN D DIAZ
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Credential |
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Telephone | 917-770-5946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 048339-1
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License Number State | NY
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