| Organization Name: | PROSPECT DENTAL, PC |
| NPI Number: | 1316333297 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICK MASCARENHAS (OWNER) |
| Mailing Address: | 288th Main Street Beacon |
| State: | NY US |
| Postal Code: | 12508 |
| Phone Number: | 8458380086 |
| Fax Number: | 8457652929 |
| NPI Enumeration Date: | 04/08/2015 |
| NPI Last Update Date: | 04/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |