Healthcare Provider Details

I. General information

NPI: 1881340636
Provider Name (Legal Business Name): CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 SARATOGA RD
GLENVILLE NY
12302-5429
US

IV. Provider business mailing address

493 SARATOGA RD
GLENVILLE NY
12302-5429
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-4031
  • Fax: 518-384-3315
Mailing address:
  • Phone: 518-399-4031
  • Fax: 518-384-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CELIA HAYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-2100