1205985595 NPI number — JAMES STREET DENTAL ARTS, PC

Table of content: (NPI 1205985595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205985595 NPI number — JAMES STREET DENTAL ARTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES STREET DENTAL ARTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHERIDAN, EDWARDS, FRENCH AND CORSO, DENTISTS, PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205985595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3309 JAMES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13206-2343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-463-0295
Provider Business Mailing Address Fax Number:
315-463-0341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3309 JAMES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13206-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-463-0295
Provider Business Practice Location Address Fax Number:
315-463-0341
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORSO
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
315-463-0295

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  049010 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 039196 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 039484 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 030571 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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