Provider Demographics
NPI:1568736429
Name:LOAN S. MAO, DDS PC
Entity Type:Organization
Organization Name:LOAN S. MAO, DDS PC
Other - Org Name:MT. KISCO PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-725-2172
Mailing Address - Street 1:1416 146TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2436
Mailing Address - Country:US
Mailing Address - Phone:510-725-2172
Mailing Address - Fax:
Practice Address - Street 1:105 S BEDFORD RD
Practice Address - Street 2:315
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3441
Practice Address - Country:US
Practice Address - Phone:510-725-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty