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General NPI Number Information
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NPI Number | 1942001078
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Entity Type | Organization
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Legal Business Name | HARBORSIDE DENTAL TEAM AT CANANDAIGUA
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 3170 WEST ST STE 250
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1786
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Country | US
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Telephone | 585-394-3737
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Fax | 585-394-3891
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Provider Business Mailing Address
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Address Line | 3170 WEST ST STE 250
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1786
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Country | US
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Telephone | 585-208-9285
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Fax | 585-208-9285
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN J ANTETOMASO
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Credential | DMD
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Telephone | 585-394-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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