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General NPI Number Information
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NPI Number | 1366988735
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Entity Type | Organization
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Legal Business Name | LOUIS S PROFERA DDS PLLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 65 MONTAUK HWY SUITE E
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City | EAST HAMPTON
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State | NY
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Zip | 11937-3285
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Country | US
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Telephone | 631-324-5662
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Fax |
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Provider Business Mailing Address
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Address Line | 65 MONTAUK HWY SUITE E
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City | EAST HAMPTON
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State | NY
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Zip | 11937-3285
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Country | US
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Telephone | 631-324-5662
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOUIS S PROFERA
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Credential |
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Telephone | 631-324-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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