Provider Demographics
NPI:1982787537
Name:UNIVERSITY OF ROCHESTER
Entity Type:Organization
Organization Name:UNIVERSITY OF ROCHESTER
Other - Org Name:EASTMAN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-275-3300
Mailing Address - Street 1:625 ELMWOOD AVE
Mailing Address - Street 2:BOX 683
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2913
Mailing Address - Country:US
Mailing Address - Phone:585-275-5022
Mailing Address - Fax:585-276-0293
Practice Address - Street 1:625 ELMWOOD AVE
Practice Address - Street 2:BOX 683
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2913
Practice Address - Country:US
Practice Address - Phone:585-275-5022
Practice Address - Fax:585-276-0293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ROCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355239Medicaid
NY7165OtherBLUE SHIELD