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General NPI Number Information
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NPI Number | 1831897396
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Entity Type | Organization
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Legal Business Name | WATKINS GLEN FAMILY DENTISTRY P.L.L.C.
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 703 S DECATUR ST
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City | WATKINS GLEN
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State | NY
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Zip | 14891-1614
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Country | US
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Telephone | 607-535-4666
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Fax | 607-535-4287
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Provider Business Mailing Address
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Address Line | 703 S DECATUR ST
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City | WATKINS GLEN
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State | NY
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Zip | 14891-1614
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Country | US
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Telephone | 607-535-4666
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Fax | 607-535-4287
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOSHUA HAENTGES
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Credential | DDS
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Telephone | 607-535-4666
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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 |
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License Number State |
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