Provider Demographics
NPI:1588843106
Name:CRANBERRY DENTAL MANAGEMENT CO., INC.
Entity Type:Organization
Organization Name:CRANBERRY DENTAL MANAGEMENT CO., INC.
Other - Org Name:ROCHESTER ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-442-1492
Mailing Address - Street 1:10 HAGEN DR STE 230
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2659
Mailing Address - Country:US
Mailing Address - Phone:585-442-1492
Mailing Address - Fax:585-586-4460
Practice Address - Street 1:10 HAGEN DR STE 230
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2659
Practice Address - Country:US
Practice Address - Phone:585-442-1492
Practice Address - Fax:585-586-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty