Provider Demographics
NPI:1578780656
Name:ASPEN DENTAL OF CENTRAL NEW YORK
Entity Type:Organization
Organization Name:ASPEN DENTAL OF CENTRAL NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCD
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-454-6000
Mailing Address - Street 1:124 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4108
Mailing Address - Country:US
Mailing Address - Phone:315-455-2411
Mailing Address - Fax:
Practice Address - Street 1:124 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4108
Practice Address - Country:US
Practice Address - Phone:315-454-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty