Provider Demographics
NPI:1376997908
Name:COSMETIC DENTISTRY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:COSMETIC DENTISTRY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-364-0400
Mailing Address - Street 1:1540 ROUTE 202 STE 14
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2922
Mailing Address - Country:US
Mailing Address - Phone:845-364-0400
Mailing Address - Fax:845-364-5189
Practice Address - Street 1:1540 ROUTE 202 STE 14
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2922
Practice Address - Country:US
Practice Address - Phone:845-364-0400
Practice Address - Fax:845-364-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036021-1122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty