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General NPI Number Information
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NPI Number | 1427170844
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Entity Type | Organization
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Legal Business Name | CANANDAIGUA PEDIATRIC DENTISTRY ,PC
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 WEST ST SUITE 101
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1723
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Country | US
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Telephone | 585-394-4058
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Fax | 585-394-4058
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Provider Business Mailing Address
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Address Line | 325 WEST ST SUITE 101
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1723
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Country | US
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Telephone | 585-394-4058
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Fax | 585-394-4058
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK E WOHLFELD
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Credential | DDS
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Telephone | 585-394-4058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 035232
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License Number State | NY
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