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General NPI Number Information
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NPI Number | 1336378900
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Entity Type | Individual
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Provider Name | DARA ALEXIS PFEFFER DMD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2009
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 135-14 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-997-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 8 POND PARK ROAD
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City | GREAT NECK
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State | NY
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Zip | 11023
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Country | US
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Telephone | 516-972-2765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 055540
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 055540
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License Number State | NY
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