1245373133 NPI number — CAPITAL AREA HUDSON VALLEY NY DENTAL, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245373133 NPI number — CAPITAL AREA HUDSON VALLEY NY DENTAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL AREA HUDSON VALLEY NY DENTAL, 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:
Provider Other Organization Name Type Code:
6
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:
1245373133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SARATOGA VILLAGE BLVD
Provider Second Line Business Mailing Address:
SUITE 36A
Provider Business Mailing Address City Name:
BALLSTON SPA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-3737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-899-9783
Provider Business Mailing Address Fax Number:
518-899-4007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 HAMBURG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12303-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-630-0154
Provider Business Practice Location Address Fax Number:
518-630-0159
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUTTON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
518-828-3007

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)





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