Provider Demographics
NPI:1023490257
Name:EASTMAN INSTITUTE FOR ORAL HEALTH
Entity type:Organization
Organization Name:EASTMAN INSTITUTE FOR ORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTRAR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-275-9801
Mailing Address - Street 1:60 CRITTENDEN BLVD APT 917
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4046
Mailing Address - Country:US
Mailing Address - Phone:310-739-5718
Mailing Address - Fax:
Practice Address - Street 1:60 CRITTENDEN BLVD APT 917
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4046
Practice Address - Country:US
Practice Address - Phone:310-739-5718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ROCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty