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General NPI Number Information
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NPI Number | 1922794429
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Entity Type | Organization
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Legal Business Name | NEW ROCHELLE DENTAL ARTS
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 466 MAIN ST STE 101
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-6488
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Country | US
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Telephone | 914-633-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 466 MAIN ST STE 101
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-6488
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Country | US
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Telephone | 914-633-5050
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CHAD HENDRICKS
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Credential |
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Telephone | 612-859-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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