Provider Demographics
NPI:1932321379
Name:MULDORF, LES (DMD)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:
Last Name:MULDORF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VASSAR RD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5244
Mailing Address - Country:US
Mailing Address - Phone:845-462-2636
Mailing Address - Fax:845-462-5324
Practice Address - Street 1:30 VASSAR RD
Practice Address - Street 2:SUITE 6B
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5244
Practice Address - Country:US
Practice Address - Phone:845-462-2636
Practice Address - Fax:845-462-5324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0295441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics