Provider Demographics
NPI:1770631277
Name:ROCHESTER PERIODONTAL GROUP PC
Entity type:Organization
Organization Name:ROCHESTER PERIODONTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OREN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:585-442-0690
Mailing Address - Street 1:900 WESTFALL RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2635
Mailing Address - Country:US
Mailing Address - Phone:585-442-0690
Mailing Address - Fax:585-442-8474
Practice Address - Street 1:900 WESTFALL RD STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2635
Practice Address - Country:US
Practice Address - Phone:585-442-0690
Practice Address - Fax:585-442-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty