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General NPI Number Information
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NPI Number | 1992165146
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Entity Type | Organization
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Legal Business Name | MY SARATOGA DENTIST PLLC
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 569 N BROADWAY SUITE 1
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-1646
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Country | US
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Telephone | 518-633-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 569 N BROADWAY SUITE 1
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-1646
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Country | US
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Telephone | 518-584-9172
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RYAN P OSINSKI
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Credential | DDS
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Telephone | 518-633-4226
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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 | 052055
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License Number State | NY
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