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General NPI Number Information
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NPI Number | 1568736429
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Entity Type | Organization
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Legal Business Name | LOAN S. MAO, DDS PC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 105 S BEDFORD RD 315
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3441
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Country | US
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Telephone | 510-725-2172
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 146TH ST
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City | WHITESTONE
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State | NY
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Zip | 11357-2436
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Country | US
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Telephone | 510-725-2172
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LOAN S MAO
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Credential | DDS
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Telephone | 510-725-2172
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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 | 054287
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License Number State | NY
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