=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710052220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COXSACKIE DENTAL ARTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12077 ROUTE 9W
-----------------------------------------------------
City | WEST COXSACKIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12192-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-731-8008
-----------------------------------------------------
Fax | 518-731-6719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12077 ROUTE 9W
-----------------------------------------------------
City | WEST COXSACKIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12192-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KURT FROEHLICH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 518-731-8008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 041941
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------