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General NPI Number Information
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NPI Number | 1134341720
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTIC ASSOCIATES LLP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 153 RIVERSIDE DRIVE
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City | BINGHAMTON
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State | NY
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Zip | 13905-4218
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Country | US
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Telephone | 607-723-3274
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Fax |
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Provider Business Mailing Address
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Address Line | 153 RIVERSIDE DRIVE
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City | BINGHAMTON
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State | NY
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Zip | 13905-4218
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Country | US
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Telephone | 607-723-3274
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER DENTIST
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Name | JOSEPH PETER MCMENAMIN
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Credential |
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Telephone | 607-723-3274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | NY
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