Provider Demographics
NPI:1063294718
Name:AESTHETIC DENTISTRY OF EAST GREENBUSH
Entity type:Organization
Organization Name:AESTHETIC DENTISTRY OF EAST GREENBUSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-956-2883
Mailing Address - Street 1:739 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2231
Mailing Address - Country:US
Mailing Address - Phone:518-477-1008
Mailing Address - Fax:
Practice Address - Street 1:739 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2231
Practice Address - Country:US
Practice Address - Phone:518-477-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental