=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548619729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KTS FAMILY DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2016
-----------------------------------------------------
Last Update Date | 06/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 458 MAPLE AVE
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-5532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-583-9834
-----------------------------------------------------
Fax | 518-583-9834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CINNAMON LN
-----------------------------------------------------
City | HALFMOON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-2685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-912-0079
-----------------------------------------------------
Fax | 518-583-9834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER/DENTIST
-----------------------------------------------------
Name | KARAMDEEP SINGH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 917-912-0079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 126800000X
-----------------------------------------------------
Taxonomy Name | Dental Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 056615
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------