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General NPI Number Information
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NPI Number | 1538883954
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN AT MT. KISCO PC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 111 E. MAIN ST.
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City | MT. KISCO
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State | NY
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Zip | 10549
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Country | US
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Telephone | 914-864-0464
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Fax | 914-864-0465
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Provider Business Mailing Address
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Address Line | 111 E. MAIN ST.
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City | MT. KISCO
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State | NY
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Zip | 10549
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Country | US
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Telephone | 914-864-0464
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Fax | 914-864-0465
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE GOMEZ
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Credential | DMD
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Telephone | 914-630-2600
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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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