Provider Demographics
NPI:1235637141
Name:CORNERSTONE DENTAL OF HENRIETTA
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL OF HENRIETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MALATESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-865-7030
Mailing Address - Street 1:3770 MT. READ BLVD.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616
Mailing Address - Country:US
Mailing Address - Phone:585-865-7030
Mailing Address - Fax:
Practice Address - Street 1:2104 E. HENRIETTA ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-334-8350
Practice Address - Fax:585-334-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty