Organization
KEVIN POUPORE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN POUPORE DDS (CEO)
(518) 483-3100
Entity
Organization
Contact information
Practice address
560 E MAIN ST, MALONE, NY 12953-2048
(518) 483-3100
(518) 483-3109
Mailing address
560 E MAIN ST, MALONE, NY 12953-2048
(518) 483-3100
(518) 483-3109
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215057260
NPI
NY
01
—
1457022352
NPI
NY
Enumeration date
10/18/2022
Last updated
10/18/2022
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