Provider Demographics
NPI:1669513685
Name:PULTORAK, FRANCIS STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:STANLEY
Last Name:PULTORAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12816-1004
Mailing Address - Country:US
Mailing Address - Phone:518-677-3633
Mailing Address - Fax:518-677-3633
Practice Address - Street 1:14 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1004
Practice Address - Country:US
Practice Address - Phone:518-677-3633
Practice Address - Fax:518-677-3633
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist