Provider Demographics
NPI:1225184377
Name:GRUFFI, DOUGLAS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:GRUFFI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ROUTE 304
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3037
Mailing Address - Country:US
Mailing Address - Phone:845-634-0404
Mailing Address - Fax:845-634-6084
Practice Address - Street 1:515 ROUTE 304
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3037
Practice Address - Country:US
Practice Address - Phone:845-634-0404
Practice Address - Fax:845-634-6084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0419121223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01189844Medicaid