MEDICARE: CENTRAL SQUARE DENTAL ASSOCIATES

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		NY

General Provider Information

NPI Number	:	1699926717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL SQUARE DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	3033 EAST AVE
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2611
Country	:	US
Telephone Number	:	315-668-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 EAST AVE
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2611
Country	:	US
Telephone Number	:	315-668-5600
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. FRANK MARRANO
Credential	:
Telephone Number	:	315-214-0666

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	07/21/2022

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