Provider Demographics
NPI:1174994529
Name:WHITE PLAINS DENTAL PROVIDER PLLC
Entity type:Organization
Organization Name:WHITE PLAINS DENTAL PROVIDER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-683-5203
Mailing Address - Street 1:10 MITCHELL PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4300
Mailing Address - Country:US
Mailing Address - Phone:914-683-5203
Mailing Address - Fax:914-289-0846
Practice Address - Street 1:10 MITCHELL PL STE 102
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4300
Practice Address - Country:US
Practice Address - Phone:914-683-5203
Practice Address - Fax:914-289-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050677-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty