Provider Demographics
NPI:1023131059
Name:ATLANTIS DENTAL HEALTH
Entity type:Organization
Organization Name:ATLANTIS DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:SCHWARTZ
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-949-0648
Mailing Address - Street 1:505 CENTRAL AVE
Mailing Address - Street 2:107
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1539
Mailing Address - Country:US
Mailing Address - Phone:914-949-0648
Mailing Address - Fax:
Practice Address - Street 1:505 CENTRAL AVE
Practice Address - Street 2:107
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1539
Practice Address - Country:US
Practice Address - Phone:914-949-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039668-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty