Provider Demographics
NPI:1295558807
Name:JONATHAN ADLER, DDS, PLLC
Entity type:Organization
Organization Name:JONATHAN ADLER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-513-2663
Mailing Address - Street 1:300 GLENMOSE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3881
Mailing Address - Country:US
Mailing Address - Phone:585-513-2663
Mailing Address - Fax:
Practice Address - Street 1:300 GLENMOSE RD STE 301
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3881
Practice Address - Country:US
Practice Address - Phone:585-513-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental