Provider Demographics
NPI:1740407691
Name:MASCI, PETER V (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:V
Last Name:MASCI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1544
Mailing Address - Country:US
Mailing Address - Phone:845-778-5763
Mailing Address - Fax:845-778-1823
Practice Address - Street 1:88 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1544
Practice Address - Country:US
Practice Address - Phone:845-778-5763
Practice Address - Fax:845-778-1823
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0394551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice