Provider Demographics
NPI:1750657557
Name:COMPLETE DENTAL CARE, PC
Entity Type:Organization
Organization Name:COMPLETE DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ILAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-737-1911
Mailing Address - Street 1:1019 PARK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3814
Mailing Address - Country:US
Mailing Address - Phone:914-737-1911
Mailing Address - Fax:914-737-1943
Practice Address - Street 1:1019 PARK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3814
Practice Address - Country:US
Practice Address - Phone:914-737-1911
Practice Address - Fax:914-737-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051103261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental