Healthcare Provider Details

I. General information

NPI: 1427137264
Provider Name (Legal Business Name): PAUL CAIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ORINOCO DR
BRIGHTWATERS NY
11718-1822
US

IV. Provider business mailing address

232 ORINOCO DR
BRIGHTWATERS NY
11718-1822
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-7008
  • Fax: 631-666-7009
Mailing address:
  • Phone: 631-666-7008
  • Fax: 631-666-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number032814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: