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General NPI Number Information
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NPI Number | 1902372667
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Entity Type | Organization
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Legal Business Name | GH DENTAL OF CNY, PLLC
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 7264 OSWEGO RD
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City | LIVERPOOL
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State | NY
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Zip | 13090-3719
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Country | US
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Telephone | 315-453-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 7264 OSWEGO RD
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City | LIVERPOOL
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State | NY
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Zip | 13090-3719
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Country | US
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Telephone | 315-453-3003
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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. GREGORY HERMAN
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Credential | DMD
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Telephone | 315-569-0287
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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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