Healthcare Provider Details

I. General information

NPI: 1154477602
Provider Name (Legal Business Name): ROBERT S SZYMCZAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CO HWY 155
BROADALBIN NY
12025
US

IV. Provider business mailing address

PO BOX 351 116 CO HWY 155
BROADALBIN NY
12025
US

V. Phone/Fax

Practice location:
  • Phone: 518-883-5858
  • Fax:
Mailing address:
  • Phone: 518-883-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: