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General NPI Number Information
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NPI Number | 1891020475
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Entity Type | Organization
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Legal Business Name | ACCESS FAMILY DENTAL AND DENTURES
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 219 COUNTY ROUTE 57 THREE RIVERS PLAZA
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City | PHOENIX
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State | NY
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Zip | 13135-3300
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Country | US
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Telephone | 315-695-2128
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Fax |
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Provider Business Mailing Address
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Address Line | 219 COUNTY RTE 57 THREE RIVERS PLAZA
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City | PHOENIX
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State | NY
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Zip | 13135
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Country | US
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Telephone | 315-695-2128
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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. THOMAS B. NOLAN
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Credential | DDS
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Telephone | 315-695-2128
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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 | 027837
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 027837
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License Number State | NY
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