MEDICARE: MOTIVATIONAL DENTISTRY P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1346954732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATIONAL DENTISTRY P C

Provider Business Mailing Address
First Line	:	97 1/2 GEORGE ST
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12183-1115
Country	:	US
Telephone Number	:	518-308-4200
Fax Number	:	518-308-4300

Provider Business Practice Location Address
First Line	:	97 1/2 GEORGE ST
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12183-1115
Country	:	US
Telephone Number	:	518-308-4200
Fax Number	:	518-308-4300

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. SHONTERAL LAKAY REDMOND
Credential	:	DDS
Telephone Number	:	607-591-2305

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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Directions to “MOTIVATIONAL DENTISTRY P C ” Practice Location

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