Provider Demographics
NPI:1700540986
Name:DENTISTRY FOR CHILDREN AT HASTINGS PC
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN AT HASTINGS 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:914-478-8585
Mailing Address - Street 1:615 BROADWAY, HASTINGS
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 BROADWAY, HASTINGS
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706
Practice Address - Country:US
Practice Address - Phone:914-478-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty