1548498587 NPI number — ALBANY ACCESS DENTISTRY, PLLC

Table of content: (NPI 1548498587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548498587 NPI number — ALBANY ACCESS DENTISTRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBANY ACCESS DENTISTRY, PLLC
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:
Provider Other Organization Name Type Code:
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:
1548498587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12205-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-464-0402
Provider Business Mailing Address Fax Number:
518-464-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
618 CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37219-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-750-0342
Provider Business Practice Location Address Fax Number:
615-750-0304
Provider Enumeration Date:
06/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TRUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, LICENSING & CREDENTIALING
Authorized Official Telephone Number:
615-750-0342

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03195631 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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