Provider Demographics
NPI:1114666351
Name:PALMA AND NARDOZZA DENTAL SERVICES, PC
Entity Type:Organization
Organization Name:PALMA AND NARDOZZA DENTAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-272-4735
Mailing Address - Street 1:30 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1126
Mailing Address - Country:US
Mailing Address - Phone:315-635-3671
Mailing Address - Fax:315-635-6482
Practice Address - Street 1:30 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1126
Practice Address - Country:US
Practice Address - Phone:315-635-3671
Practice Address - Fax:315-635-6482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMA AND NARDOZZA DENTAL SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042879OtherNEW YORK STATE BOARD FOR DENTISTRY