=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902814064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONGERS DENTAL CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 LAKE RD SUITE 4
-----------------------------------------------------
City | CONGERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10920-2251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-268-3304
-----------------------------------------------------
Fax | 845-268-3349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 LAKE RD SUITE 4
-----------------------------------------------------
City | CONGERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10920-2251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-268-3304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALKA PATEL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 845-268-3304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 042456
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------