# IDENT DENTAL AT MIDDLETOWN

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

## Provider details

- **NPI number:** 1811121379
- **Authorized official:** ADAM SPOSATO (ADMINISTRATOR)
- **Authorized official phone:** (914) 245-4332

## Contact information

- **Practice address:** 453 ROUTE 211 E, SUITE 103, MIDDLETOWN, NY 10940-2206
- **Practice address phone:** (888) 433-6820
- **Mailing address:** 453 ROUTE 211 E, SUITE 103, MIDDLETOWN, NY 10940-2206
- **Mailing address phone:** (888) 433-6820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 048328 | NY | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 049967 | NY | Yes |
| 1223P0300X | Periodontics | 051732 | NY | — |

## Other

- **Enumeration date:** 05/12/2009
- **Last updated:** 05/12/2009