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General NPI Number Information
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NPI Number | 1922238450
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Entity Type | Individual
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Provider Name | ROSSARIN MITSUMOTO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 245 N BROADWAY SUITE 108
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-2670
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Country | US
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Telephone | 914-332-1272
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Fax | 914-332-1261
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Provider Business Mailing Address
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Address Line | 245 N BROADWAY SUITE 108
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-2670
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Country | US
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Telephone | 914-332-1272
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Fax | 914-332-1261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 055068
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License Number State | NY
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