Provider Demographics
NPI:1457487928
Name:CHARLES D AZZARETTI DDS AND ELLEN G HOLLIDAY DDS
Entity Type:Organization
Organization Name:CHARLES D AZZARETTI DDS AND ELLEN G HOLLIDAY DDS
Other - Org Name:AZZARETTI AND HOLLIDAY DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-666-3310
Mailing Address - Street 1:439 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3404
Mailing Address - Country:US
Mailing Address - Phone:914-666-3310
Mailing Address - Fax:914-666-7924
Practice Address - Street 1:439 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3404
Practice Address - Country:US
Practice Address - Phone:914-666-3310
Practice Address - Fax:914-666-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36579122300000X
NY36012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty