Provider Demographics
NPI:1558573147
Name:DAVIDSON DDS, KEATINFG DDS, LLP
Entity Type:Organization
Organization Name:DAVIDSON DDS, KEATINFG DDS, LLP
Other - Org Name:FINGERLAKES SMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-252-7278
Mailing Address - Street 1:68 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-252-7278
Mailing Address - Fax:315-252-7279
Practice Address - Street 1:68 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-252-7278
Practice Address - Fax:315-252-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0314161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty