Organization
EXCELDENT OF ORANGE SULLIVAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI RIVAS (OFFICE MANAGER)
(845) 794-0706
Entity
Organization
Contact information
Practice address
523 BROADWAY, MONTICELLO, NY 12701
(845) 794-0706
(845) 794-0606
Mailing address
523 BROADWAY, MONTICELLO, NY 12701-1111
(845) 794-0706
(845) 794-0606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
041682-1
NY
122300000X
Dentist
044624-1
PA
122300000X
Dentist
050306
NY
122300000X
Dentist
054091
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
026906
NY
Other
Enumeration date
04/07/2009
Last updated
04/07/2009
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