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General NPI Number Information
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NPI Number | 1326414699
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Entity Type | Organization
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Legal Business Name | CROSSKEYS DENTAL
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 110 CROSS KEYS OFFICE PARK
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City | FAIRPORT
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State | NY
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Zip | 14450-3509
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Country | US
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Telephone | 585-223-8690
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Fax | 585-223-8938
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Provider Business Mailing Address
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Address Line | 110 CROSS KEYS OFFICE PARK
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City | FAIRPORT
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State | NY
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Zip | 14450-3509
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Country | US
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Telephone | 585-223-8690
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Fax | 585-223-8938
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT E DUPRE
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Credential | DMD
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Telephone | 585-223-8690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 041330
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License Number State | NY
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