Provider Demographics
NPI:1639389851
Name:NEW ROC DENTAL PC
Entity Type:Organization
Organization Name:NEW ROC DENTAL PC
Other - Org Name:NEW ROC SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OVRAL
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:WYNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-235-8065
Mailing Address - Street 1:271 NORTH AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5104
Mailing Address - Country:US
Mailing Address - Phone:914-235-8065
Mailing Address - Fax:914-235-8066
Practice Address - Street 1:271 NORTH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5104
Practice Address - Country:US
Practice Address - Phone:914-235-8065
Practice Address - Fax:914-235-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02373619Medicaid