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NPI 1710247580

NPI 1710247580 : HUDSON VALLEY PLAZA DENTAL LLP : TROY, NY

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General NPI Number Information
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    NPI Number           |    1710247580
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    Entity Type          |    Organization 
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    Legal Business Name  |    HUDSON VALLEY PLAZA DENTAL LLP 
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Dates
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    Enumeration Date     |    05/25/2012
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    Last Update Date     |    05/25/2012
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Provider Practice Location Address
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    Address Line         |    79 VANDENBURGH AVE 
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    City                 |    TROY
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    State                |    NY
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    Zip                  |    12180-6024
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    Country              |    US
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    Telephone            |    518-273-7777
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    79 VANDENBURGH AVE 
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    City                 |    TROY
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    State                |    NY
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    Zip                  |    12180-6024
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    Country              |    US
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    Telephone            |    518-273-7777
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     ROSS  KRASNOV 
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    Credential           |    DDS
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    Telephone            |    518-273-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    046043
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    License Number State |    NY
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