MEDICARE: AUBURN SMILES DENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619430022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUBURN SMILES DENTISTRY

Provider Business Mailing Address
First Line	:	5 LOCK ST
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-2506
Country	:	US
Telephone Number	:	315-439-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 GENESEE ST
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-3370
Country	:	US
Telephone Number	:	315-638-0276
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KIMBER CUMMINGS
Credential	:
Telephone Number	:	315-439-9975

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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Directions to “AUBURN SMILES DENTISTRY ” Practice Location

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