Provider Demographics
NPI:1043789639
Name:SMALL TO TALL, DENTISTRY FOR CHILDREN, PLLC
Entity Type:Organization
Organization Name:SMALL TO TALL, DENTISTRY FOR CHILDREN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:MATHEWS
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-747-1587
Mailing Address - Street 1:3171 CHILI AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5440
Mailing Address - Country:US
Mailing Address - Phone:585-889-1290
Mailing Address - Fax:585-889-1345
Practice Address - Street 1:3171 CHILI AVE STE 400
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5440
Practice Address - Country:US
Practice Address - Phone:585-889-1290
Practice Address - Fax:585-889-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366543613OtherNPPES
NY046302OtherNY STATE EDUCATION DEPARTMENT
NY02558092Medicaid