Provider Demographics
NPI:1912576398
Name:DENTISTRY FOR CHILDREN AT PEEKSKILL PC
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN AT PEEKSKILL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-630-2600
Mailing Address - Street 1:22 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2944
Practice Address - Country:US
Practice Address - Phone:914-630-2600
Practice Address - Fax:914-930-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty