Provider Demographics
NPI:1851803753
Name:ACHURY & PUERTA DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:ACHURY & PUERTA DENTAL SERVICES PLLC
Other - Org Name:VANGUARD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-739-4990
Mailing Address - Street 1:601 FRANKLIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5760
Mailing Address - Country:US
Mailing Address - Phone:516-739-4990
Mailing Address - Fax:516-396-2212
Practice Address - Street 1:601 FRANKLIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5760
Practice Address - Country:US
Practice Address - Phone:516-739-4990
Practice Address - Fax:516-396-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental