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General NPI Number Information
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NPI Number | 1992948608
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Entity Type | Organization
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Legal Business Name | PLANET SMILE DENTAL, P.C.
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 10 FISKE PL SUITE 501
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3205
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Country | US
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Telephone | 914-668-7500
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Fax | 914-668-7007
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Provider Business Mailing Address
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Address Line | 10 FISKE PLACE SUITE 501
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City | MOUNT VERNON
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State | NY
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Zip | 10550
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Country | US
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Telephone | 914-668-7500
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Fax | 914-668-7007
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GARY D HEITZLER
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Credential | DDS
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Telephone | 914-668-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 044619
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License Number State | NY
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