Provider Demographics
NPI:1548402142
Name:JEFFERSON VALLEY DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JEFFERSON VALLEY DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:LUGAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-245-4760
Mailing Address - Street 1:P.O. BOX 489
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535
Mailing Address - Country:US
Mailing Address - Phone:914-245-4760
Mailing Address - Fax:914-243-9861
Practice Address - Street 1:3654 LEE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535
Practice Address - Country:US
Practice Address - Phone:914-245-4760
Practice Address - Fax:914-243-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453301223G0001X
NY044.6721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty