Provider Demographics
NPI:1346506078
Name:EPSTEIN, GARY FRANK (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:FRANK
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2126
Mailing Address - Country:US
Mailing Address - Phone:518-483-5958
Mailing Address - Fax:518-483-5958
Practice Address - Street 1:451 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2126
Practice Address - Country:US
Practice Address - Phone:518-483-5958
Practice Address - Fax:518-483-5958
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607323Medicaid