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General NPI Number Information
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NPI Number | 1730580671
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Entity Type | Organization
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Legal Business Name | DAHLIA DENTAL PC
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 4298 STATE HIGHWAY 30
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City | AMSTERDAM
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State | NY
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Zip | 12010-6204
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Country | US
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Telephone | 518-842-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 4298 STATE HIGHWAY 30
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City | AMSTERDAM
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State | NY
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Zip | 12010-6204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. SANDRA MCNEAL
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Credential | DMD, MD
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Telephone | 518-842-0800
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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 | 053982
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License Number State | NY
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