Destine, Edly
Destine, Edly is an sole proprietor health care provider with primary practice located at 88 W Lincoln Ave Ste 102 , Mount Vernon NY 10550-1181. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Destine, Edly can be contacted via phone (146) 996-9889.Contact Information
Primary practice address
88 W Lincoln Ave Ste 102
Mount Vernon NY 10550-1181
Phone: (146) 996-9889
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 057473 | New York |
Profile Details
| NPI number | 1326387341 |
|---|---|
| LBN Legal business name | Destine, Edly |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 11th, 2013 |
| Last updated | Nov 9th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326387341 | NPPES |
| New York | MEDICAID | 04140667 |
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