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General NPI Number Information
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NPI Number | 1003486945
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Entity Type | Organization
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Legal Business Name | CLIFTON PARK PERIODONTICS AND DENTAL IMPLANTS, PLLC
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1536 CRESCENT RD STE B8
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City | CLIFTON PARK
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State | NY
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Zip | 12065-7729
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Country | US
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Telephone | 518-313-6091
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 CRESCENT RD STE B8
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City | CLIFTON PARK
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State | NY
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Zip | 12065-7729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LINDA LAM
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Credential |
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Telephone | 518-631-5988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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