Healthcare Provider Details

I. General information

NPI: 1467721662
Provider Name (Legal Business Name): KENNETH D SCHWARTZ DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 UNION ST
SCHENECTADY NY
12308-3103
US

IV. Provider business mailing address

833 UNION ST
SCHENECTADY NY
12308-3103
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-1935
  • Fax: 518-374-1982
Mailing address:
  • Phone: 518-374-1935
  • Fax: 518-374-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number032763
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENNETH D SCHWARTZ
Title or Position: OWNER
Credential: DDS
Phone: 518-374-1935