Provider Demographics
NPI:1568674182
Name:MARCI MENDOLA-PITCHER DDS LLC
Entity Type:Organization
Organization Name:MARCI MENDOLA-PITCHER DDS LLC
Other - Org Name:ROSEN PITCHER DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOLA-PITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-586-2222
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1925
Mailing Address - Country:US
Mailing Address - Phone:585-586-2222
Mailing Address - Fax:585-381-4043
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1925
Practice Address - Country:US
Practice Address - Phone:585-586-2222
Practice Address - Fax:585-381-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00450546Medicaid
NY02365942Medicaid