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General NPI Number Information
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NPI Number | 1306528708
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Entity Type | Organization
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Legal Business Name | SYRACUSE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 3112 ERIE BLVD E
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City | SYRACUSE
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State | NY
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Zip | 13214-1202
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Country | US
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Telephone | 607-953-4797
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BEECH ST
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1018
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Country | US
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Telephone | 607-953-4797
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROBERT A LALOR
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Credential | DDS
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Telephone | 607-743-8551
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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 |
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License Number State |
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