Provider Demographics
NPI:1649477266
Name:MASRY, OLIVIA (DDS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MASRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CHAPPAQUA RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1354
Mailing Address - Country:US
Mailing Address - Phone:914-762-4422
Mailing Address - Fax:
Practice Address - Street 1:312 CHAPPAQUA RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1354
Practice Address - Country:US
Practice Address - Phone:914-762-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0315831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice