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General NPI Number Information
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NPI Number | 1639190986
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Entity Type | Organization
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Legal Business Name | PARKWAY DENTAL PRACTICE, PC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 ANNETTA ST
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City | VESTAL
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State | NY
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Zip | 13850-2301
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Country | US
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Telephone | 607-798-7188
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Fax | 607-797-8435
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Provider Business Mailing Address
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Address Line | 105 ANNETTA ST
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City | VESTAL
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State | NY
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Zip | 13850-2301
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Country | US
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Telephone | 607-798-7188
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Fax | 607-797-8435
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. HAROLD W CALLAGHAN
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Credential | DDS
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Telephone | 607-798-7188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 031189
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License Number State | NY
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