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General NPI Number Information
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NPI Number | 1144453226
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Entity Type | Organization
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Legal Business Name | CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 1662 CENTRAL AVE STE 2
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City | ALBANY
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State | NY
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Zip | 12205-4060
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Country | US
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Telephone | 518-452-2121
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Fax | 518-456-2865
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Provider Business Mailing Address
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Address Line | 1662 CENTRAL AVE STE 2
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City | ALBANY
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State | NY
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Zip | 12205-4060
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Country | US
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Telephone | 518-452-2121
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Fax | 518-456-2865
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CELIA HAYES
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Credential |
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Telephone | 217-540-2100
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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 | 42469
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License Number State | NY
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