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General NPI Number Information
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NPI Number | 1023490257
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Entity Type | Organization
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Legal Business Name | EASTMAN INSTITUTE FOR ORAL HEALTH
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 60 CRITTENDEN BLVD APT 917
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City | ROCHESTER
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State | NY
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Zip | 14620-4046
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Country | US
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Telephone | 310-739-5718
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Fax |
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Provider Business Mailing Address
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Address Line | 60 CRITTENDEN BLVD APT 917
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City | ROCHESTER
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State | NY
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Zip | 14620-4046
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Country | US
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Telephone | 310-739-5718
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Fax |
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Authorized Official
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Title or Position | REGISTRAR
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Name | MRS. VANESSA BUCKHOLZ
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Credential |
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Telephone | 585-275-9801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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