Healthcare Provider Details

I. General information

NPI: 1326503988
Provider Name (Legal Business Name): ABBY K PHILBRICK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LN
CANTON NY
13617-3739
US

IV. Provider business mailing address

4 COMMERCE LN
CANTON NY
13617-3739
US

V. Phone/Fax

Practice location:
  • Phone: 315-379-8119
  • Fax:
Mailing address:
  • Phone: 315-379-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number029968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: