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General NPI Number Information
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NPI Number | 1497051643
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Entity Type | Organization
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Legal Business Name | EVAN M. DENTES, M.D., P.C.
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD SUITE 2Q
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-457-7290
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Fax | 315-451-1663
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Provider Business Mailing Address
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Address Line | 5100 W TAFT RD SUITE 2Q
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-457-7290
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Fax | 315-451-1663
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Authorized Official
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Title or Position | OWNER
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Name | DR. EVAN M DENTES
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Credential | M.D.
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Telephone | 315-457-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 131699-1
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License Number State | NY
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