Provider Demographics
NPI:1104287762
Name:MID HUDSON DENTAL IMPLANT AND ORAL SURGERY PC
Entity type:Organization
Organization Name:MID HUDSON DENTAL IMPLANT AND ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-452-5805
Mailing Address - Street 1:11 RAYMOND AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2330
Mailing Address - Country:US
Mailing Address - Phone:845-452-5805
Mailing Address - Fax:845-454-2496
Practice Address - Street 1:11 RAYMOND AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2330
Practice Address - Country:US
Practice Address - Phone:845-452-5805
Practice Address - Fax:845-454-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH ARCURI DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046472261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental