Provider Demographics
NPI:1669654844
Name:GENESEE DENTAL SERVICES
Entity Type:Organization
Organization Name:GENESEE DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:HSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-476-7479
Mailing Address - Street 1:610 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3524
Mailing Address - Country:US
Mailing Address - Phone:315-476-7479
Mailing Address - Fax:315-473-9853
Practice Address - Street 1:610 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3524
Practice Address - Country:US
Practice Address - Phone:315-476-7479
Practice Address - Fax:315-473-9853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESEE DENTAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-29
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042499-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty