Provider Demographics
NPI:1316337413
Name:DINOSAUR DENTAL, PLLC
Entity type:Organization
Organization Name:DINOSAUR DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-754-2217
Mailing Address - Street 1:1700 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5512
Mailing Address - Country:US
Mailing Address - Phone:607-754-2217
Mailing Address - Fax:
Practice Address - Street 1:1700 MONROE ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5512
Practice Address - Country:US
Practice Address - Phone:607-754-2217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty