Provider Demographics
NPI:1467583716
Name:RYE BROOK DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RYE BROOK DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-251-0117
Mailing Address - Street 1:3010 WESTCHESTER AVE
Mailing Address - Street 2:SUITE#202
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2535
Mailing Address - Country:US
Mailing Address - Phone:914-251-0117
Mailing Address - Fax:914-251-0254
Practice Address - Street 1:3010 WESTCHESTER AVE
Practice Address - Street 2:SUITE#202
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2535
Practice Address - Country:US
Practice Address - Phone:914-251-0117
Practice Address - Fax:914-251-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042549-11223G0001X
NY0211131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty