Provider Demographics
NPI:1558778142
Name:URGENT CARE DENTAL, LLC
Entity Type:Organization
Organization Name:URGENT CARE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOESER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-713-3500
Mailing Address - Street 1:1088 CENTRAL AVENUE
Mailing Address - Street 2:STORE #3
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-713-3500
Mailing Address - Fax:914-713-8874
Practice Address - Street 1:1088 CENTRAL AVENUE
Practice Address - Street 2:STORE #3
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-713-3500
Practice Address - Fax:914-713-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047100-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty