Provider Demographics
NPI:1356841753
Name:PEWARSKI, MARIAH (DMD)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PEWARSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 SUMMERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5479
Mailing Address - Country:US
Mailing Address - Phone:914-472-2929
Mailing Address - Fax:
Practice Address - Street 1:188 SUMMERFIELD ST
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5479
Practice Address - Country:US
Practice Address - Phone:914-472-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0621211223G0001X, 1223X0400X
NJ22DI028232001223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program