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General NPI Number Information
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NPI Number | 1215080205
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Entity Type | Organization
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Legal Business Name | HOMETOWN DENTAL GROUP, PC
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 34 BUCKMAN RD
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City | ROCHESTER
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State | NY
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Zip | 14615-1406
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Country | US
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Telephone | 585-309-1710
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Fax | 585-227-5215
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Provider Business Mailing Address
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Address Line | 34 BUCKMAN RD
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City | ROCHESTER
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State | NY
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Zip | 14615-1406
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Country | US
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Telephone | 585-227-4390
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Fax | 585-227-5215
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Authorized Official
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Title or Position | VP
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Name | DR. PAUL I SUSSMAN
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Credential | DMD
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Telephone | 585-227-4390
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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 | 34610
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35176
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License Number State | NY
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