Provider Demographics
NPI:1689119455
Name:EFROS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:EFROS ORTHODONTICS PLLC
Other - Org Name:EFROS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:
Authorized Official - Last Name:EFROS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:845-331-7356
Mailing Address - Street 1:149 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2811
Mailing Address - Country:US
Mailing Address - Phone:856-331-7356
Mailing Address - Fax:845-331-7768
Practice Address - Street 1:149 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2811
Practice Address - Country:US
Practice Address - Phone:856-331-7356
Practice Address - Fax:845-331-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058564-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty