Provider Demographics
NPI:1598411357
Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Entity Type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1207 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1003
Mailing Address - Country:US
Mailing Address - Phone:518-785-3084
Mailing Address - Fax:518-785-0243
Practice Address - Street 1:1207 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1003
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:518-785-0243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty