# IDENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326289695
- **Authorized official:** KARISSA PUCCI (VICE PRESIDENT)
- **Authorized official phone:** (845) 437-4380

## Contact information

- **Practice address:** 2600 SOUTH RD, SUITE 21 A, POUGHKEEPSIE, NY 12601-7003
- **Practice address phone:** (845) 437-4380
- **Mailing address:** 2600 SOUTH RD, SUITE 21 A, POUGHKEEPSIE, NY 12601-7003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2009
- **Last updated:** 03/17/2009