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General NPI Number Information
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NPI Number | 1912338674
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Entity Type | Organization
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Legal Business Name | UPSTATE NEW YORK DENTAL PC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 30 W STATE ST
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City | BINGHAMTON
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State | NY
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Zip | 13901-2332
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Country | US
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Telephone | 607-238-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 30 W STATE ST
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City | BINGHAMTON
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State | NY
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Zip | 13901-2332
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Country | US
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Telephone | 607-238-1280
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NANARAO KROTHAPALLI
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Credential | DMD
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Telephone | 617-223-1652
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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 | 056567-1
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License Number State | NY
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