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NPI Code Detail

MEDICARE: DR. CLEVE RONALD EADS DMD

MEDICARE: DR. CLEVE RONALD EADS DMD
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
11223G0001XGeneral Practice DentistryD9127AZ
2122300000XDentist044287NY

General Provider Information

NPI Number : 1598970279
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLEVE RONALD EADS DMD
Provider Business Mailing Address
First Line : 12K MAJESTY WAY
Second Line :
City : MECHANICVILLE
State : NY
Zip : 12118-3160
Country : US
Telephone Number : 518-859-7795
Fax Number :
Provider Business Practice Location Address
First Line : 286 CHURCH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-9208
Country : US
Telephone Number : 518-584-8150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 04/11/2019

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