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General NPI Number Information
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NPI Number | 1811385826
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Entity Type | Organization
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Legal Business Name | APPLE BLOSSOM DENTAL,PLLC
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 3800 RAILROAD AVE
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City | WILLIAMSON
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State | NY
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Zip | 14589-9340
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Country | US
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Telephone | 315-589-4471
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Fax | 315-589-9427
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Provider Business Mailing Address
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Address Line | 3800 RAILROAD AVE
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City | WILLIAMSON
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State | NY
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Zip | 14589-9340
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Country | US
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Telephone | 315-589-4471
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Fax | 315-589-9427
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Authorized Official
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Title or Position | DDS
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Name | FETHIYE SEVDE ERSAN
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Credential |
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Telephone | 315-589-4471
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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 | 053718
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License Number State | NY
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