Provider Demographics
NPI:1578225595
Name:HARBORSIDE DENTAL TEAM
Entity Type:Organization
Organization Name:HARBORSIDE DENTAL TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-671-2720
Mailing Address - Street 1:1695 EMPIRE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2191
Mailing Address - Country:US
Mailing Address - Phone:585-671-2720
Mailing Address - Fax:
Practice Address - Street 1:1695 EMPIRE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2191
Practice Address - Country:US
Practice Address - Phone:585-671-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental