Provider Demographics
NPI:1114359387
Name:CAPITAL AREA HUDSON VALLEY NY DENTAL PC
Entity Type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NY DENTAL PC
Other - Org Name:1ST ADVANTAGE DENTAL QUEENSBURY US 9
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-587-3831
Mailing Address - Street 1:6 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5601
Mailing Address - Country:US
Mailing Address - Phone:518-348-0240
Mailing Address - Fax:518-348-0248
Practice Address - Street 1:123 QUAKER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1714
Practice Address - Country:US
Practice Address - Phone:518-746-4125
Practice Address - Fax:518-746-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty