Provider Demographics
NPI:1144581562
Name:SKANEATELES DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SKANEATELES DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-685-7162
Mailing Address - Street 1:645 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9363
Mailing Address - Country:US
Mailing Address - Phone:315-685-7162
Mailing Address - Fax:315-685-2055
Practice Address - Street 1:645 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9363
Practice Address - Country:US
Practice Address - Phone:315-685-7162
Practice Address - Fax:315-685-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty