Provider Demographics
NPI:1013338417
Name:AJR FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:AJR FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-295-2257
Mailing Address - Street 1:56 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5038
Mailing Address - Country:US
Mailing Address - Phone:516-208-8300
Mailing Address - Fax:
Practice Address - Street 1:56 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5038
Practice Address - Country:US
Practice Address - Phone:516-208-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574827Medicaid