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General NPI Number Information
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NPI Number | 1285171926
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Entity Type | Organization
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Legal Business Name | FINGER LAKES PERIODONTICS PLLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 600 KREAG RD
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City | PITTSFORD
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State | NY
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Zip | 14534-3746
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Country | US
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Telephone | 585-248-8195
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Fax | 585-248-8256
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Provider Business Mailing Address
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Address Line | 600 KREAG RD
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City | PITTSFORD
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State | NY
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Zip | 14534-3746
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Country | US
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Telephone | 585-248-8195
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Fax | 585-248-8256
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Authorized Official
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Title or Position | PARTNER
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Name | DR. SEAN W MEITNER
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Credential | DDS
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Telephone | 585-248-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 056700
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 031468
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License Number State | NY
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