Provider Demographics
NPI:1740463561
Name:PURE DENTAL, PC
Entity type:Organization
Organization Name:PURE DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-886-9555
Mailing Address - Street 1:14748 ROOSEVELT AVE
Mailing Address - Street 2:SUITE #L-6
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4706
Mailing Address - Country:US
Mailing Address - Phone:718-886-9555
Mailing Address - Fax:718-886-9557
Practice Address - Street 1:14748 ROOSEVELT AVE
Practice Address - Street 2:SUITE #L-6
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4706
Practice Address - Country:US
Practice Address - Phone:718-886-9555
Practice Address - Fax:718-886-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-15
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049108261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental