MEDICARE: HOMETOWN DENTAL CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	044725	NY

General Provider Information

NPI Number	:	1245234590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN DENTAL CARE, P.C.

Provider Business Mailing Address
First Line	:	350 MAIN ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-1530
Country	:	US
Telephone Number	:	518-747-6453
Fax Number	:	518-747-4434

Provider Business Practice Location Address
First Line	:	350 MAIN ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-1530
Country	:	US
Telephone Number	:	518-747-6453
Fax Number	:	518-747-4434

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH EDWARD POTVIN
Credential	:	DDS
Telephone Number	:	518-747-6453

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/23/2007

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