Healthcare Provider Details

I. General information

NPI: 1245340660
Provider Name (Legal Business Name): JULIAN KAHN PASCO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 CLINTON AVE S
ROCHESTER NY
14618-5620
US

IV. Provider business mailing address

1950 CLINTON AVE S
ROCHESTER NY
14618-5620
US

V. Phone/Fax

Practice location:
  • Phone: 585-461-4350
  • Fax: 585-461-9365
Mailing address:
  • Phone: 585-461-4350
  • Fax: 585-461-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number052698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: