Provider Demographics
NPI:1972271005
Name:ROCHESTER PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:ROCHESTER PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-381-2190
Mailing Address - Street 1:145 SULLYS TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4561
Mailing Address - Country:US
Mailing Address - Phone:585-381-2190
Mailing Address - Fax:585-381-2198
Practice Address - Street 1:145 SULLYS TRL STE 1
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4561
Practice Address - Country:US
Practice Address - Phone:585-381-2190
Practice Address - Fax:585-381-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04805038Medicaid
NY02635096Medicaid