Provider Demographics
NPI:1144377482
Name:DENTAL HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:DENTAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ-ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-592-2400
Mailing Address - Street 1:29 CROSSROADS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069
Mailing Address - Country:US
Mailing Address - Phone:315-592-2400
Mailing Address - Fax:315-592-2400
Practice Address - Street 1:29 CROSSROADS DRIVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069
Practice Address - Country:US
Practice Address - Phone:315-592-2400
Practice Address - Fax:315-592-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052831-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty