Provider Demographics
NPI:1154445146
Name:JOHNF MENARD DDS PC
Entity Type:Organization
Organization Name:JOHNF MENARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-853-2412
Mailing Address - Street 1:6 E PARK ROW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1544
Mailing Address - Country:US
Mailing Address - Phone:315-853-2412
Mailing Address - Fax:315-853-3892
Practice Address - Street 1:6 E PARK ROW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1544
Practice Address - Country:US
Practice Address - Phone:315-853-2412
Practice Address - Fax:315-853-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty