Provider Demographics
NPI:1639196637
Name:SARATOGA COUNTY ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:SARATOGA COUNTY ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITACRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-583-4497
Mailing Address - Street 1:4 CARE LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8624
Mailing Address - Country:US
Mailing Address - Phone:518-583-4497
Mailing Address - Fax:518-583-3779
Practice Address - Street 1:4 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8624
Practice Address - Country:US
Practice Address - Phone:518-583-4497
Practice Address - Fax:518-583-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty