MEDICARE: ALBANY ACCESS DENTISTRY, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548498587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY ACCESS DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	1839 CENTRAL AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-4748
Country	:	US
Telephone Number	:	518-464-0402
Fax Number	:	518-464-0409

Provider Business Practice Location Address
First Line	:	618 CHURCH ST
Second Line	:	SUITE 520
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2428
Country	:	US
Telephone Number	:	615-750-0342
Fax Number	:	615-750-0304

Authorized Official
Title or Position	:	DIRECTOR, LICENSING & CREDENTIALING
Name	:	MS. TRUDY WILLIAMS
Credential	:
Telephone Number	:	615-750-0342

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	05/13/2010

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