Provider Demographics
NPI:1366988735
Name:LOUIS S PROFERA DDS PLLC
Entity type:Organization
Organization Name:LOUIS S PROFERA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:PROFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-324-5662
Mailing Address - Street 1:65 MONTAUK HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-3285
Mailing Address - Country:US
Mailing Address - Phone:631-324-5662
Mailing Address - Fax:
Practice Address - Street 1:65 MONTAUK HWY
Practice Address - Street 2:SUITE E
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-3285
Practice Address - Country:US
Practice Address - Phone:631-324-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty