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General NPI Number Information
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NPI Number | 1245234590
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Entity Type | Organization
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Legal Business Name | HOMETOWN DENTAL CARE, P.C.
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 350 MAIN ST
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City | HUDSON FALLS
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State | NY
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Zip | 12839-1530
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Country | US
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Telephone | 518-747-6453
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Fax | 518-747-4434
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Provider Business Mailing Address
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Address Line | 350 MAIN ST
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City | HUDSON FALLS
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State | NY
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Zip | 12839-1530
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Country | US
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Telephone | 518-747-6453
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Fax | 518-747-4434
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH EDWARD POTVIN
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Credential | DDS
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Telephone | 518-747-6453
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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 | 044725
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License Number State | NY
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