=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619403185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEWELL PEDIATRIC DENTISTRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2017
-----------------------------------------------------
Last Update Date | 05/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2607 NY 52, SUITE H
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-447-1550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2607 NY 52, SUITE H
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. LAWRENCE LIMB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-558-6908
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 0475501
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------