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General NPI Number Information
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NPI Number | 1811160567
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Entity Type | Organization
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Legal Business Name | AHLGRIM AND WARD DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 125 MULLIN ST
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City | WATERTOWN
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State | NY
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Zip | 13601-3615
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Country | US
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Telephone | 315-782-2241
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Fax | 315-785-5521
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Provider Business Mailing Address
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Address Line | 125 MULLIN ST
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City | WATERTOWN
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State | NY
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Zip | 13601-3615
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Country | US
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Telephone | 315-782-2241
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Fax | 315-785-5521
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN ARTHUR AHLGRIM
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Credential | DMD
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Telephone | 315-782-2241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 39123
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License Number State | NY
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