Healthcare Provider Details

I. General information

NPI: 1710052220
Provider Name (Legal Business Name): COXSACKIE DENTAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12077 ROUTE 9W
WEST COXSACKIE NY
12192-1308
US

IV. Provider business mailing address

12077 ROUTE 9W
WEST COXSACKIE NY
12192-1308
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-8008
  • Fax: 518-731-6719
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041941
License Number StateNY

VIII. Authorized Official

Name: DR. KURT FROEHLICH
Title or Position: DENTIST
Credential: DDS
Phone: 518-731-8008