Provider Demographics
NPI:1215009600
Name:TWIN TIERS DENTAL PLLC
Entity Type:Organization
Organization Name:TWIN TIERS DENTAL PLLC
Other - Org Name:TWIN TIERS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:V
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-732-5190
Mailing Address - Street 1:420 WEST WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905
Mailing Address - Country:US
Mailing Address - Phone:607-732-5190
Mailing Address - Fax:
Practice Address - Street 1:420 WEST WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905
Practice Address - Country:US
Practice Address - Phone:607-732-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty