Provider Demographics
NPI:1942926209
Name:KEVIN POUPORE DDS PC
Entity Type:Organization
Organization Name:KEVIN POUPORE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POUPORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-483-3100
Mailing Address - Street 1:560 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2048
Mailing Address - Country:US
Mailing Address - Phone:518-483-3100
Mailing Address - Fax:518-483-3109
Practice Address - Street 1:560 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2048
Practice Address - Country:US
Practice Address - Phone:518-483-3100
Practice Address - Fax:518-483-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1457022352OtherNPI
NY1215057260OtherNPI