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General NPI Number Information
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NPI Number | 1891761318
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Entity Type | Organization
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Legal Business Name | PINE STREET DENTAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 138 PINE ST SUITE 210
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City | KINGSTON
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State | NY
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Zip | 12401-4947
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Country | US
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Telephone | 845-338-6900
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Fax | 845-338-6013
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Provider Business Mailing Address
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Address Line | 138 PINE ST SUITE 210
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City | KINGSTON
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State | NY
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Zip | 12401-4947
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Country | US
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Telephone | 845-338-6900
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Fax | 845-338-6013
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Authorized Official
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Title or Position | DENTIST, OWNER
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Name | DR. CHARLES MATTHEW FLIEGLER
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Credential | D.D.S.
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Telephone | 845-338-6900
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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 | 032380
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 040046
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0487491
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 038724
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 044009
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0526781
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 029231
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License Number State | NY
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