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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1023041985

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 518-463-9809  Fax: 518-434-2595

Contact information for business:
45 LANSING DR  DELMAR, NY 12054-2735 US
Tel: --  Fax: --

Registration Information:
NPI: 1023041985
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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