Provider Demographics
NPI:1073805503
Name:DENTCARE DENTAL SERVICES
Entity Type:Organization
Organization Name:DENTCARE DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-362-2098
Mailing Address - Street 1:11 ARCADIAN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1125
Mailing Address - Country:US
Mailing Address - Phone:845-262-2098
Mailing Address - Fax:845-362-2098
Practice Address - Street 1:11 ARCADIAN DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1125
Practice Address - Country:US
Practice Address - Phone:845-262-2098
Practice Address - Fax:845-362-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty