Provider Demographics
NPI:1386882298
Name:WALK IN FAMILY DENTAL OFFICE
Entity type:Organization
Organization Name:WALK IN FAMILY DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-576-7126
Mailing Address - Street 1:95 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-576-7126
Mailing Address - Fax:914-654-8986
Practice Address - Street 1:95 UNION AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-576-7126
Practice Address - Fax:914-654-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048509-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty