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General NPI Number Information
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NPI Number | 1457869224
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Entity Type | Organization
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Legal Business Name | TICONDEROGA DENTAL PLAZA, PC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1019 WICKER ST
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City | TICONDEROGA
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State | NY
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Zip | 12883-1039
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Country | US
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Telephone | 518-825-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 304 W BAY PLZ
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1787
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. MORRIS E FEINBERG
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Credential | DMD
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Telephone | 518-825-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 000649
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License Number State | NY
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