# DR. JAIME M. POULOS, DDS P.C.

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

## Provider details

- **NPI number:** 1609397108
- **Authorized official:** DR. JAIME M POULOS DDS (PRESIDENT)
- **Authorized official phone:** (631) 673-3755

## Contact information

- **Practice address:** 120 NEW YORK AVE STE 2W, HUNTINGTON, NY 11743-2743
- **Practice address phone:** (631) 673-3755
- **Practice address fax:** (631) 673-3343
- **Mailing address:** 7 LAWRENCE HILL RD STE 1, HUNTINGTON, NY 11743-3143
- **Mailing address phone:** (631) 673-3755
- **Mailing address fax:** (631) 673-3433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/05/2017
- **Last updated:** 04/09/2024