Provider Demographics
NPI:1205118700
Name:EXCELDENT DENTAL OF MONROE, LLP
Entity type:Organization
Organization Name:EXCELDENT DENTAL OF MONROE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-783-1311
Mailing Address - Street 1:3 CENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4805
Mailing Address - Country:US
Mailing Address - Phone:845-783-1311
Mailing Address - Fax:845-782-0825
Practice Address - Street 1:3 CENTER HILL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4805
Practice Address - Country:US
Practice Address - Phone:845-783-1311
Practice Address - Fax:845-782-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty