MEDICARE: DR. DIPTI DAS DDS

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	041163	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	18321	OTHER	NY	FIDELISCARE

General Provider Information

NPI Number	:	1659360444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIPTI DAS DDS

Provider Business Mailing Address
First Line	:	4 LOCHNESS LN
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-1504
Country	:	US
Telephone Number	:	845-947-1577
Fax Number	:	845-947-1723

Provider Business Practice Location Address
First Line	:	49 W BROAD ST
Second Line	:
City	:	HAVERSTRAW
State	:	NY
Zip	:	10927-1621
Country	:	US
Telephone Number	:	845-947-1577
Fax Number	:	845-947-1723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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