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General NPI Number Information
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NPI Number | 1689064123
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Entity Type | Organization
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Legal Business Name | TRUMANSBURG FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 50 E. MAIN ST
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City | TRUMANSBURG
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State | NY
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Zip | 14886
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Country | US
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Telephone | 607-387-7821
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Fax | 607-387-9893
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Provider Business Mailing Address
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Address Line | PO BOX 446 50 E. MAIN ST
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City | TRUMANSBURG
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State | NY
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Zip | 14886-0446
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Country | US
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Telephone | 607-387-7821
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Fax | 607-387-9893
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Authorized Official
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Title or Position | SECRETARY
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Name | JOANNA HICKOK
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Credential |
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Telephone | 315-771-9532
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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 |
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License Number State |
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