MEDICARE: EXCELDENT DENTAL OF SUFFERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124132261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELDENT DENTAL OF SUFFERN

Provider Business Mailing Address
First Line	:	5 HEMION RD
Second Line	:
City	:	MONTEBELLO
State	:	NY
Zip	:	10901-4903
Country	:	US
Telephone Number	:	845-357-3244
Fax Number	:	845-357-3251

Provider Business Practice Location Address
First Line	:	5 HEMION RD
Second Line	:
City	:	MONTEBELLO
State	:	NY
Zip	:	10901-4903
Country	:	US
Telephone Number	:	845-357-3244
Fax Number	:	845-357-3251

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY JOZEL PAUWELS
Credential	:
Telephone Number	:	845-357-3244

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	04/10/2009

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