Provider Demographics
NPI:1043629454
Name:EAST ENDS TOOTH FERRY PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:EAST ENDS TOOTH FERRY PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:REINHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-728-1215
Mailing Address - Street 1:315 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5051
Mailing Address - Country:US
Mailing Address - Phone:631-204-5700
Mailing Address - Fax:631-204-5701
Practice Address - Street 1:315 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5051
Practice Address - Country:US
Practice Address - Phone:631-204-5700
Practice Address - Fax:631-204-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty