Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0358741 | NY |
NPI | 1013042050 |
---|---|
Provider Name | Kevin Edmond Cresci |
First Address | Dover Plains, NY 12522-5822 |
Second Address | Dover Plains, NY 12522-5935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 31/03/2014 |