Provider Demographics
NPI:1477804474
Name:NEW ROCHELLE DENTAL STUDIO PC.
Entity Type:Organization
Organization Name:NEW ROCHELLE DENTAL STUDIO PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-770-5946
Mailing Address - Street 1:199 NORTH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-633-5601
Mailing Address - Fax:914-633-5222
Practice Address - Street 1:199 NORTH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-633-5601
Practice Address - Fax:914-633-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048339-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental