Provider Demographics
NPI:1205699519
Name:NEW YORK DENTAL SERVICE PROVIDERS, PLLC
Entity type:Organization
Organization Name:NEW YORK DENTAL SERVICE PROVIDERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIREC OF CRED AND PROV REL
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:V
Authorized Official - Last Name:DASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-638-0303
Mailing Address - Street 1:1610 54TH AVE N STE 205
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5000
Practice Address - Country:US
Practice Address - Phone:914-472-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK DENTAL SERVICE PROVIDERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty