Provider Demographics
NPI:1053557041
Name:WESTCHESTER SMILE DESIGN DENTISTRY, PC
Entity type:Organization
Organization Name:WESTCHESTER SMILE DESIGN DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:TERRIE
Authorized Official - Last Name:CALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-241-8200
Mailing Address - Street 1:39 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2838
Mailing Address - Country:US
Mailing Address - Phone:914-241-8200
Mailing Address - Fax:914-241-3073
Practice Address - Street 1:39 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2838
Practice Address - Country:US
Practice Address - Phone:914-241-8200
Practice Address - Fax:914-241-3073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCHESTER SMILE DESIGN DENTISTRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041695-2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental