MEDICARE: DR. ERIC C DUMOND DDS

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	1223G0001X	General Practice Dentistry	030102	NY

General Provider Information

NPI Number	:	1619091428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC C DUMOND DDS

Provider Business Mailing Address
First Line	:	P.O.BOX 557
Second Line	:
City	:	UNION SPRINGS
State	:	NY
Zip	:	13160
Country	:	US
Telephone Number	:	315-889-7347
Fax Number	:	315-889-7340

Provider Business Practice Location Address
First Line	:	207 N. CAYUGA STREET
Second Line	:
City	:	UNION SPRINGS
State	:	NY
Zip	:	13160
Country	:	US
Telephone Number	:	315-889-7347
Fax Number	:	315-889-7340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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