Provider Demographics
NPI:1437810900
Name:CLINTON DENTAL P.C.
Entity Type:Organization
Organization Name:CLINTON DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARDUGNO
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:13323-1583
Mailing Address - Country:US
Mailing Address - Phone:315-853-2412
Mailing Address - Fax:
Practice Address - Street 1:6 E PARK ROW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1583
Practice Address - Country:US
Practice Address - Phone:315-853-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty