1649445602 NPI number — EAST SIDE SMILE SOLUTIONS DENTISTRY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649445602 NPI number — EAST SIDE SMILE SOLUTIONS DENTISTRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SIDE SMILE SOLUTIONS DENTISTRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EAST SIDE SMILE SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649445602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 E 83RD ST
Provider Second Line Business Mailing Address:
PROF SUITE
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10028-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-249-0877
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 E 83RD ST
Provider Second Line Business Practice Location Address:
PROF SUITE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10028-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-0877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PURPURA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER/PRESIDENT/DENTIST
Authorized Official Telephone Number:
212-249-0877

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  043135-02 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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