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NPI Code Detail

MEDICARE: MICHAEL J. MEDLER DDS

MEDICARE: MICHAEL J. MEDLER DDS
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
1122300000XDentist051205NY

General Provider Information

NPI Number : 1639231970
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J. MEDLER DDS
Provider Business Mailing Address
First Line : 47 KINGWOOD DR
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12601-5404
Country : US
Telephone Number : 845-454-7023
Fax Number : 845-454-7064
Provider Business Practice Location Address
First Line : 876 DUTCHESS TPKE
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12603-1540
Country : US
Telephone Number : 845-454-7023
Fax Number : 845-454-7064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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