Provider Demographics
NPI:1598495962
Name:ONCE UPON A TOOTH PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ONCE UPON A TOOTH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:LISNEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-348-4348
Mailing Address - Street 1:54 SAGAMORE RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 WHITE PLAINS RD STE C-1
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4423
Practice Address - Country:US
Practice Address - Phone:914-348-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty