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NPI Code Detail

MEDICARE: CHAPPAQUA DENTISTRY, P.C.

MEDICARE: CHAPPAQUA DENTISTRY, P.C.
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
1261QD0000XDental Clinic/Center039826NY

General Provider Information

NPI Number : 1578058202
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHAPPAQUA DENTISTRY, P.C.
Provider Business Mailing Address
First Line : 30 N GREELEY AVE
Second Line :
City : CHAPPAQUA
State : NY
Zip : 10514-3410
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30 N GREELEY AVE
Second Line :
City : CHAPPAQUA
State : NY
Zip : 10514-3410
Country : US
Telephone Number : 914-238-8200
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. STEVEN A. BRISMAN
Credential : DMD
Telephone Number : 914-238-8200
Provider Enumeration Date : 06/25/2018
Last Update Date : 06/25/2018

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