Provider Demographics
NPI:1275922213
Name:ROCKLAND DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:ROCKLAND DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-634-8900
Mailing Address - Street 1:238 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5302
Mailing Address - Country:US
Mailing Address - Phone:845-634-8900
Mailing Address - Fax:845-634-3978
Practice Address - Street 1:238 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5302
Practice Address - Country:US
Practice Address - Phone:845-634-8900
Practice Address - Fax:845-634-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0563161223G0001X
NY0530401223P0221X
NY0544061223X0400X
NY0545831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty