Healthcare Provider Details

I. General information

NPI: 1912013962
Provider Name (Legal Business Name): LOUIS S PROFERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MONTAUK HWY SUITE E
EAST HAMPTON NY
11937
US

IV. Provider business mailing address

65 MONTAUK HWY SUITE E
EAST HAMPTON NY
11937
US

V. Phone/Fax

Practice location:
  • Phone: 631-324-5662
  • Fax: 631-324-5835
Mailing address:
  • Phone: 631-324-5662
  • Fax: 631-324-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: