Healthcare Provider Details

I. General information

NPI: 1144649443
Provider Name (Legal Business Name): NATHAN TYLER CARY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST
CANANDAIGUA NY
14424-1022
US

IV. Provider business mailing address

875 UNION AVE
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-3322
  • Fax: 585-394-1175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number059773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: