Provider Demographics
NPI:1134516552
Name:SOUTHERN TIER DENTISTRY, PC
Entity Type:Organization
Organization Name:SOUTHERN TIER DENTISTRY, PC
Other - Org Name:ELMIRA FAMILY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-926-5050
Mailing Address - Street 1:315 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2601
Mailing Address - Country:US
Mailing Address - Phone:607-734-8511
Mailing Address - Fax:607-734-6486
Practice Address - Street 1:315 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2601
Practice Address - Country:US
Practice Address - Phone:607-734-8511
Practice Address - Fax:607-734-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty