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General NPI Number Information
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NPI Number | 1043629454
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Entity Type | Organization
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Legal Business Name | EAST ENDS TOOTH FERRY PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 315 MEETING HOUSE LN
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5051
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Country | US
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Telephone | 631-204-5700
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Fax | 631-204-5701
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Provider Business Mailing Address
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Address Line | 315 MEETING HOUSE LN
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5051
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Country | US
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Telephone | 631-204-5700
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Fax | 631-204-5701
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. GREGORY JAMES REINHOLD
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Credential | DMD
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Telephone | 631-728-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 053854
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License Number State | NY
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