Provider Demographics
NPI:1609141142
Name:PULLANO DENTAL OF CLAY
Entity Type:Organization
Organization Name:PULLANO DENTAL OF CLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-622-4200
Mailing Address - Street 1:3881 STATE ROUTE 31
Mailing Address - Street 2:
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:
Practice Address - Street 1:3881 STATE ROUTE 31
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty