Provider Demographics
NPI:1134501356
Name:GIDEON OCHIABUTO DENTISTRY PC
Entity Type:Organization
Organization Name:GIDEON OCHIABUTO DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:I
Authorized Official - Last Name:OCHIABUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-218-7366
Mailing Address - Street 1:521 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1917
Mailing Address - Country:US
Mailing Address - Phone:315-218-7366
Mailing Address - Fax:315-469-7060
Practice Address - Street 1:521 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1917
Practice Address - Country:US
Practice Address - Phone:315-218-7366
Practice Address - Fax:315-469-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053709-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty