Provider Demographics
NPI:1225280613
Name:RICHARD ESMAY,DDS & MARK POLSINELLODMD.PC
Entity Type:Organization
Organization Name:RICHARD ESMAY,DDS & MARK POLSINELLODMD.PC
Other - Org Name:LASTING IMPRESSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLSINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-438-1131
Mailing Address - Street 1:399 ALBANY SHAKER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1970
Mailing Address - Country:US
Mailing Address - Phone:518-438-1131
Mailing Address - Fax:
Practice Address - Street 1:399 ALBANY SHAKER RD STE 201
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1970
Practice Address - Country:US
Practice Address - Phone:518-438-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300441223G0001X
NY0454651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty