=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598041170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULLANO DENTAL OF CLAY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3881 STATE ROUTE 31 SUITE 400
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13090-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-622-4200
-----------------------------------------------------
Fax | 315-622-4222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3881 STATE ROUTE 31 SUITE 400
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13090-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-622-4200
-----------------------------------------------------
Fax | 315-622-4222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM M PULLANO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 315-703-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 0447461
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------