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General NPI Number Information
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NPI Number | 1437183647
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Entity Type | Organization
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Legal Business Name | CALLAHAN, FLANAGAN & SMITH ORTHODONTICS
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 S MANLIUS ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2041
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Country | US
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Telephone | 315-637-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S MANLIUS ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2041
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Country | US
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Telephone | 315-637-2674
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JOHN D CALLAHAN JR.
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Credential | DDS
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Telephone | 315-637-2674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 036509-1
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License Number State | NY
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