NPI: 1265696058 · PORT JERVIS, NY 12771 · General Practice Dentistry · NPI assigned 07/11/2008
| Authorized Official | DESILVA, SUJATHA (DENTIST) |
| NPI Enumeration Date | 07/11/2008 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 13 | $364.50 |
| 2022 | 15 | $421.08 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 28 | 28 | $785.58 |