Provider Demographics
NPI:1275688004
Name:CANALVIEW DENTAL ASSOCIATES DDS LLP
Entity Type:Organization
Organization Name:CANALVIEW DENTAL ASSOCIATES DDS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-593-2506
Mailing Address - Street 1:184 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1720
Mailing Address - Country:US
Mailing Address - Phone:315-593-2506
Mailing Address - Fax:315-593-1896
Practice Address - Street 1:184 S 1ST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1720
Practice Address - Country:US
Practice Address - Phone:315-593-2506
Practice Address - Fax:315-593-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty