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General NPI Number Information
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NPI Number | 1114080041
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Entity Type | Organization
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Legal Business Name | ROME FAMILY DENTAL SERVICE P.C.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 215 NORTH WASHINGTON ST.
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City | ROME
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State | NY
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Zip | 13440
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Country | US
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Telephone | 315-339-5830
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Fax | 315-337-8409
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Provider Business Mailing Address
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Address Line | 215 NORTH WASHINGTON ST.
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City | ROME
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State | NY
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Zip | 13440
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Country | US
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Telephone | 315-339-5830
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Fax | 315-337-8409
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBINO NICHOLAS BALLINI
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Credential | DDS
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Telephone | 315-339-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 044155
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 030067
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License Number State | NY
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