Provider Demographics
NPI:1023551173
Name:TWELVE CORNERS DENTISTRY PLLC
Entity Type:Organization
Organization Name:TWELVE CORNERS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAROCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-244-1177
Mailing Address - Street 1:4 CHELMSFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1755
Mailing Address - Country:US
Mailing Address - Phone:585-244-1177
Mailing Address - Fax:
Practice Address - Street 1:4 CHELMSFORD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1755
Practice Address - Country:US
Practice Address - Phone:585-244-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty