Provider Demographics
NPI:1336378900
Name:PFEFFER, DARA ALEXIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:ALEXIS
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:ALEXIS
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:8 POND PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-972-2765
Mailing Address - Fax:
Practice Address - Street 1:135-14 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-997-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-04
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555401223P0221X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program