Provider Demographics
NPI:1477889178
Name:ASPEN DENTAL OF CENTRAL NEW YORK, PLLC
Entity Type:Organization
Organization Name:ASPEN DENTAL OF CENTRAL NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAMATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-455-2411
Mailing Address - Street 1:281 SANDERS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1307
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:315-454-8650
Practice Address - Street 1:124 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4108
Practice Address - Country:US
Practice Address - Phone:315-454-2411
Practice Address - Fax:315-455-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047142-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty