Provider Demographics
NPI:1629166533
Name:DENTRUST DENTAL NEW YORK, P.C
Entity Type:Organization
Organization Name:DENTRUST DENTAL NEW YORK, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:672-362-5938
Mailing Address - Street 1:254 CAFFERTY RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-9337
Mailing Address - Country:US
Mailing Address - Phone:610-294-7994
Mailing Address - Fax:610-294-7995
Practice Address - Street 1:254 CAFFERTY RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-9337
Practice Address - Country:US
Practice Address - Phone:610-294-7994
Practice Address - Fax:610-294-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046252-01OtherLC LIC NY