Provider Demographics
NPI:1164877288
Name:JURIM DENTAL GROUP
Entity Type:Organization
Organization Name:JURIM DENTAL GROUP
Other - Org Name:INTEGRATEDDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHICHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-677-9010
Mailing Address - Street 1:370 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2050
Mailing Address - Country:US
Mailing Address - Phone:516-677-9010
Mailing Address - Fax:
Practice Address - Street 1:370 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2050
Practice Address - Country:US
Practice Address - Phone:516-677-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0543991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty