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General NPI Number Information
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NPI Number | 1730397084
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Entity Type | Organization
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Legal Business Name | CHENANGO BRIDGE DENTAL, PLLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 528 MAIN ST.
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City | CHENANGO BRIDGE
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State | NY
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Zip | 13745
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Country | US
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Telephone | 607-648-4113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 481
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City | CHENANGO BRIDGE
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State | NY
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Zip | 13745-0481
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Country | US
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Telephone | 607-648-4113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY S ROMANOWSKI
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Credential | D.D.S.
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Telephone | 607-648-4113
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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 | 042233
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License Number State | NY
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