Provider Demographics
NPI: | 1326432949 |
---|---|
Name: | GEN OHKAWA DDS PLLC |
Entity Type: | Organization |
Organization Name: | GEN OHKAWA DDS PLLC |
Other - Org Name: | HUDSON VALLEY DENTISTRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OHKAWA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 917-721-6091 |
Mailing Address - Street 1: | 33 ROUTE 32A |
Mailing Address - Street 2: | |
Mailing Address - City: | SAUGERTIES |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12477-3711 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-678-3111 |
Mailing Address - Fax: | 518-678-1137 |
Practice Address - Street 1: | 33 ROUTE 32A |
Practice Address - Street 2: | |
Practice Address - City: | SAUGERTIES |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12477-3711 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-678-3111 |
Practice Address - Fax: | 518-678-1137 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-20 |
Last Update Date: | 2016-06-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 054989 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |