Provider Demographics
NPI:1114178415
Name:MIDDERNACHT, CAROL ONYANGO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ONYANGO
Last Name:MIDDERNACHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STONE CREST DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 PIERCE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1302
Practice Address - Country:US
Practice Address - Phone:518-373-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0546051223P0221X
NYP571281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry