Provider Demographics
NPI:1598870651
Name:MASSO, CRISTINA VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:VICTORIA
Last Name:MASSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 PARK STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566
Mailing Address - Country:US
Mailing Address - Phone:914-788-5332
Mailing Address - Fax:914-788-1261
Practice Address - Street 1:1045 PARK STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-788-5332
Practice Address - Fax:914-788-1261
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04679211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768189Medicaid