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General NPI Number Information
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NPI Number | 1932321379
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Entity Type | Individual
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Provider Name | LES MULDORF DMD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 VASSAR RD SUITE 6B
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5244
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Country | US
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Telephone | 845-462-2636
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Fax | 845-462-5324
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Provider Business Mailing Address
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Address Line | 30 VASSAR RD SUITE 6B
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5244
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Country | US
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Telephone | 845-462-2636
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Fax | 845-462-5324
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 029544
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License Number State | NY
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