MEDICARE: MY SARATOGA DENTIST 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	122300000X	Dentist	052055	NY

General Provider Information

NPI Number	:	1992165146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY SARATOGA DENTIST PLLC

Provider Business Mailing Address
First Line	:	569 N BROADWAY
Second Line	:	SUITE 1
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1646
Country	:	US
Telephone Number	:	518-584-9172
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 N BROADWAY
Second Line	:	SUITE 1
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1646
Country	:	US
Telephone Number	:	518-633-4226
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	RYAN P OSINSKI
Credential	:	DDS
Telephone Number	:	518-633-4226

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/01/2016

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