Provider Demographics
NPI:1720415565
Name:AHARON ERNAN DMD PC
Entity Type:Organization
Organization Name:AHARON ERNAN DMD PC
Other - Org Name:DENTISRY TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-919-0267
Mailing Address - Street 1:325 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2118
Mailing Address - Country:US
Mailing Address - Phone:585-919-0267
Mailing Address - Fax:585-396-0999
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2118
Practice Address - Country:US
Practice Address - Phone:585-919-0267
Practice Address - Fax:585-396-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396761375Medicaid