Provider Demographics
NPI:1235475989
Name:P.C. DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:P.C. DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-481-5733
Mailing Address - Street 1:1 GATEWAY PLZ
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4674
Mailing Address - Country:US
Mailing Address - Phone:914-481-5733
Mailing Address - Fax:914-481-5729
Practice Address - Street 1:1 GATEWAY PLZ
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4674
Practice Address - Country:US
Practice Address - Phone:914-481-5733
Practice Address - Fax:914-481-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030324122300000X
NY0561931122300000X
NY0554981122300000X
NY0513121122300000X
NY0564181122300000X
NY05188511223P0300X
NY04514611223P0700X
NY339246134124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty