1790857944 NPI number — CAPITAL AREA HUDSON VALLEY NEW YORK 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 1790857944 NPI number — CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL AREA HUDSON VALLEY NEW YORK 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:
1ST ADVANTAGE DENTAL
Provider Other Organization Name Type Code:
3
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:
1790857944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 EXECUTIVE PARK DR
Provider Second Line Business Mailing Address:
SUITE 6C
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-348-0240
Provider Business Mailing Address Fax Number:
518-348-0248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 TROY SCHENECTADY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-1028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-785-3084
Provider Business Practice Location Address Fax Number:
518-785-0243
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNOLL
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
518-587-3831

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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