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General NPI Number Information
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NPI Number | 1346361466
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Entity Type | Organization
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Legal Business Name | SENECA FAMILY DENTAL PC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5 LOCK ST
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-2506
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Country | US
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Telephone | 315-638-0276
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Fax | 315-635-7859
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Provider Business Mailing Address
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Address Line | 5 LOCK ST
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-2506
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Country | US
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Telephone | 315-638-0276
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Fax | 315-635-7859
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. RAVI C DABIR
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Credential | DDS
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Telephone | 315-638-0276
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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 | 037158
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License Number State | NY
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