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General NPI Number Information
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NPI Number | 1053438978
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Entity Type | Organization
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Legal Business Name | WILLIAM S LANCASTER, DDS HERBERT J EMMONS, DDS GARY J SURMAN, DDS D
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 DIVISION ST
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City | COBLESKILL
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State | NY
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Zip | 12043-4605
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Country | US
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Telephone | 518-827-5171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | MIDDLEBURGH
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State | NY
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Zip | 12122-0351
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Country | US
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Telephone | 518-827-5171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF PROF. CORP.
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Name | DR. HERBERT J EMMONS
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Credential | DDS
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Telephone | 518-827-5171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 029712
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License Number State | NY
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