Provider Demographics
NPI:1518024892
Name:WINDSOR DENTAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:WINDSOR DENTAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-655-2141
Mailing Address - Street 1:9 COLLEGE AVE
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4125
Mailing Address - Country:US
Mailing Address - Phone:607-655-2141
Mailing Address - Fax:607-655-3388
Practice Address - Street 1:9 COLLEGE AVE
Practice Address - Street 2:BOX 347
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4125
Practice Address - Country:US
Practice Address - Phone:607-655-2141
Practice Address - Fax:607-655-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02244939Medicaid