Healthcare Provider Details

I. General information

NPI: 1669300141
Provider Name (Legal Business Name): NNY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 GRAVES ST
CLAYTON NY
13624-1503
US

IV. Provider business mailing address

PO BOX 405
CLAYTON NY
13624-0405
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-5142
  • Fax: 315-686-2310
Mailing address:
  • Phone: 315-686-5142
  • Fax: 315-686-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SCOTT LACLAIR
Title or Position: OWNER
Credential: DDS
Phone: 315-686-5142