Provider Demographics
NPI:1598041170
Name:PULLANO DENTAL OF CLAY, PC
Entity Type:Organization
Organization Name:PULLANO DENTAL OF CLAY, PC
Other - Org Name:ORION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PULLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-703-3333
Mailing Address - Street 1:3881 STATE ROUTE 31
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1000
Mailing Address - Country:US
Mailing Address - Phone:315-622-4200
Mailing Address - Fax:315-622-4222
Practice Address - Street 1:3881 STATE ROUTE 31
Practice Address - Street 2:SUITE 400
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1000
Practice Address - Country:US
Practice Address - Phone:315-622-4200
Practice Address - Fax:315-622-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0447461261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental