Provider Demographics
NPI:1669500112
Name:NEW COUNTRY DENTAL GROUP
Entity Type:Organization
Organization Name:NEW COUNTRY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-699-1100
Mailing Address - Street 1:5972 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039
Mailing Address - Country:US
Mailing Address - Phone:315-699-1100
Mailing Address - Fax:315-699-4557
Practice Address - Street 1:5972 ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-699-1100
Practice Address - Fax:315-699-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty