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General NPI Number Information
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NPI Number | 1245605997
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Entity Type | Organization
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Legal Business Name | DR. P. TELUK, DDS, PC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 2105 W GENESEE ST
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City | SYRACUSE
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State | NY
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Zip | 13219-1656
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Country | US
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Telephone | 315-468-5076
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 WEST GENESEE ST
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City | SYRACUSE
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State | NY
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Zip | 13219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL TELUK
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Credential |
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Telephone | 315-468-5076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50099
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License Number State | NY
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