Healthcare Provider Details

I. General information

NPI: 1699075267
Provider Name (Legal Business Name): DYNAMIC DENTAL SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 GUILDERLAND AVE
SCHENECTADY NY
12306-4405
US

IV. Provider business mailing address

2210 GUILDERLAND AVE
SCHENECTADY NY
12306-4405
US

V. Phone/Fax

Practice location:
  • Phone: 518-866-0438
  • Fax: 518-344-5375
Mailing address:
  • Phone: 518-866-0438
  • Fax: 518-344-5375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041791
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY SPADARO SPADARO
Title or Position: CEO
Credential: BA
Phone: 518-688-0438