Provider Demographics
NPI:1770083321
Name:15 CANAL ROAD DENTAL SERVICES P.C.
Entity type:Organization
Organization Name:15 CANAL ROAD DENTAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-738-1144
Mailing Address - Street 1:15 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2706
Mailing Address - Country:US
Mailing Address - Phone:914-738-1144
Mailing Address - Fax:
Practice Address - Street 1:15 CANAL RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2706
Practice Address - Country:US
Practice Address - Phone:914-738-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty