Individual
DR. EDLY DESTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
88 W LINCOLN AVE STE 102, MOUNT VERNON, NY 10550-1181
(146) 996-9889
Mailing address
88 W LINCOLN AVE STE 102, MOUNT VERNON, NY 10550-1181
(914) 699-6988
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
057473
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04140667
—
NY
Enumeration date
02/11/2013
Last updated
11/09/2018
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