Healthcare Provider Details

I. General information

NPI: 1902042260
Provider Name (Legal Business Name): WIS DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 ALTAMONT AVE
SCHENECTADY NY
12303-3604
US

IV. Provider business mailing address

1875 ALTAMONT AVE
SCHENECTADY NY
12303-3604
US

V. Phone/Fax

Practice location:
  • Phone: 518-986-4355
  • Fax:
Mailing address:
  • Phone: 518-986-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number042832
License Number StateNY

VIII. Authorized Official

Name: DR. WANDA I. SALDANA
Title or Position: CEO/PRESIDENT
Credential: DDS
Phone: 518-986-4355