Provider Demographics
NPI:1497493951
Name:HUDSON VALLEY TONGUE TIED DENTAL PC
Entity Type:Organization
Organization Name:HUDSON VALLEY TONGUE TIED DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-440-3211
Mailing Address - Street 1:3630 HILL BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1506
Mailing Address - Country:US
Mailing Address - Phone:914-440-3211
Mailing Address - Fax:
Practice Address - Street 1:3630 HILL BLVD STE 401
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1506
Practice Address - Country:US
Practice Address - Phone:914-440-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty