Healthcare Provider Details

I. General information

NPI: 1841761103
Provider Name (Legal Business Name): FINGER LAKES DENTAL CARE OF PALMYRA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E MAIN ST
PALMYRA NY
14522-1144
US

IV. Provider business mailing address

329 S MAIN ST
CANANDAIGUA NY
14424-2118
US

V. Phone/Fax

Practice location:
  • Phone: 585-919-6624
  • Fax:
Mailing address:
  • Phone: 585-919-6624
  • Fax:

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: JENNIFER MORELLO
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 585-919-6624