=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710643192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA KAPNICK FDN, RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2021
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 CLUBHOUSE LN
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-403-0393
-----------------------------------------------------
Fax | 914-478-1142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 CLUBHOUSE LN
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-403-0393
-----------------------------------------------------
Fax | 914-478-1142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 017036-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------