Organization
DWAYNE M. BODIE, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWAYNE M BODIE D.M.D. (CEO/PRESIDENT)
(845) 358-5110
Entity
Organization
Contact information
Practice address
311 N MIDLAND AVE, NYACK, NY 10960-1627
(845) 358-5110
(845) 358-6740
Mailing address
311 N MIDLAND AVE, NYACK, NY 10960-1627
(845) 358-5110
(845) 358-6740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
053605
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02982507
—
NY
Enumeration date
05/04/2009
Last updated
05/04/2009
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